Pressure For Beds

Hi Guys

Im currently on a cardiothoracics clinic and managing post cardiac surgery pts. The team aims for discharge about day 5 p/o, at the moment there has been some pressure for beds up on the ward and as a result there is a bit of a pressure there to get some people out. I went to see one manwho had already been in for approxiametley 10 days on my first week. He had been experiencing shortness of breath and his chest xray showed a pleural effusion so his discharge was delayed.

The doctor's had cleared him medically, and were awaiting him to pass the stair test with us. My supervisor told me the previous day when she had walked him, he had started shivering got very SOB and was unable to continue ambulation and that she thought there was something not quite right, however the pleural effusion had not gotten any larger on subsequent chest Xrays.
walk we tried the stairs, he managed three
So I ambulated the patient and he managed the walk approx. 200m with no problems the doctors were watching and looking over my shoulder on the walk asking me how i felt he was doing. I said from the walk he was doing quite well, however he still wasnt ready to go home alone, as he was still using a walking aid due to lack of confidence and slight unsteadiness on the feet.
We tried the stairs and he managed 3 before becoming very SOB, and bursting into tears and being unable to continue. We monitored his observations and his SpO2 and HR were fine. We called the doctor's to come and see him in this state to show why we were not happy for him to go home. Over the weekend the doctor's decided to put a drain in and over 1.5L of fluid was drained.

I guess the point of the story is sometimes you can be put under a bit of pressure to give people the ok and discharge them. However if you dont think they're ready to go home then you should stick to your opinion. It can be hard esp. when these other people know alot more than you do and hold a higher position in the hierachy at the hospital.