"Responsible" Adult

[BobLoblaw78]

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I encountered PACU that sends patients home with a "responsible adult" that can be the patient's child (16-17 year-old driver). Age doesn't determine responsible adult. And I do believe that certain 17 yo's are responsible enough (even more responsible then some adults that we let take patients home.) But allowing that seems like bad policy and fraught with legal peril. Either the patient finds that legal adult or they get admitted for 23 hour observation. Maybe some rare exceptions if it is addressed days prior to surgery and discussed with anesthesia service (eg- CTR MAC case w/ known responsible 17 yo). But I have no desire to be discharge police and prefer the patient solves their issues or stay a night. Any other takes or people that are regularly dc'ing home w/ child?

Preemptively, many light sedation cases, endo cases, etc could be safe to drive before 24 hours... but is it good policy before any guidelines stating specifically.

 

[coffeebythelake]

I encountered PACU that sends patients home with a "responsible adult" that can be the patient's child (16-17 year-old driver). Age doesn't determine responsible adult. And I do believe that certain 17 yo's are responsible enough (even more responsible then some adults that we let take patients home.) But allowing that seems like bad policy and fraught with legal peril. Either the patient finds that legal adult or they get admitted for 23 hour observation. Maybe some rare exceptions if it is addressed days prior to surgery and discussed with anesthesia service (eg- CTR MAC case w/ known responsible 17 yo). But I have no desire to be discharge police and prefer the patient solves their issues or stay a night. Any other takes or people that are regularly dc'ing home w/ child?

Preemptively, many light sedation cases, endo cases, etc could be safe to drive before 24 hours... but is it good policy before any guidelines stating specifically.

Practically I agree with you and think it is fine.
Medicolegally I don't know if you would be held liable if something happened.
I don't know if it is worth the expense of keeping them in 23h obs. I would think not.
This seems like an issue that your hospital needs to codify into official policy.

 

[coffeebythelake]

On a related vein, we've had some patients want to leave after their surgery without a responsible adult. Our pre-op nurses always ask who will take them home to minimize the risk for this issue. Sometimes it is because their Medicar is running way behind. Whatever the reason isn't so important. We try to persuade them to stay but we do not physically stop them if they are determined to go. We make sure they are alert, oriented, satisfactorily recovered from the anesthetic, and that they understand the risks of leaving against advice. And document as such (which is probably the most important aspect of the interaction).

 

[Agast]

Our surgery center identifies who the driver is before the patient is allowed to come back. Very rarely do we get caught with our pants down, but I did have to call and pay for an Uber for a patient once. At least they didn’t get any sedation…

 

[coffeebythelake]

but I did have to call and pay for an Uber for a patient once.

why

 

[Agast]

why

We found out after I already did his back injection that he drove himself and he could not get in touch with anyone to drive him. Instead of going around in circles with the PACU nurses and taking up a bed I just sent him home.

 

[aneftp]

It’s stupid rules. Until the asa and other organizations change the rules. Age 18 will still be the requirement. Of course the local center can always make their own by laws. And if risk management is ok changing it to “responsible legal driver”. That would hold up in a court of law.

 

[nimbus]

We have an ophthalmologist who will occasionally drive one of his patients home.

 

[Ezekiel2517]

I had a patient the other day at the ASC whose driver was his 95 yr old mother lol

 

[repititionition]

We have an ophthalmologist who will occasionally drive one of his patients home.

 

[BobLoblaw78]

We are looking at changing policy versus enforcing the current one they have. It made me curious how many other places deal with this.

We have an ophthalmologist who will occasionally drive one of his patients home.

I had a plastic surgeon who would take patients home with him. For days. He had an extra room at his house. And I’m not making a joke about the English idiot (some British plastic surgeon slept with many of his patients).

But this guy never went to residency for plastics. He was ENT. But he didn’t complete ENT residency. He quit after one maybe two years. And his patients loved him. And nurses from the hospital would go to him knowing this. Blew my mind. So I researched it. And found out that tons of dentists also do plastic surgery, breast implants, etc.

 

[2Fast2Des]

We are looking at changing policy versus enforcing the current one they have. It made me curious how many other places deal with this.



I had a plastic surgeon who would take patients home with him. For days. He had an extra room at his house. And I’m not making a joke about the English idiot (some British plastic surgeon slept with many of his patients).

But this guy never went to residency for plastics. He was ENT. But he didn’t complete ENT residency. He quit after one maybe two years. And his patients loved him. And nurses from the hospital would go to him knowing this. Blew my mind. So I researched it. And found out that tons of dentists also do plastic surgery, breast implants, etc.

Wow that's scary, and how the hell he got credentialed?

 

[BobLoblaw78]

Wow that's scary, and how the hell he got credentialed?

He apparently started doing it in the early 80’s and just kept on. He did all the smaller procedures in his office. Just big ones in the hospital. I know the hospital changed hands but they didn’t feel like they should remove his privileges. I guess grandfathered in.

Anyone can practice with a license. Getting paid is the problem. He was a cash only business but was so cheap that patients would pay out of pocket.

 

[amyl]

We have this issue. Patients lie… they say they have someone and then they don’t… they don’t want to come back. Pacu nurses always call and want to document “md informed” that the patient is going in an Uber and doesn’t have someone to stay with them. Pacu drives me nuts about this at 8pm when I’m on call dealing with real issues - I tell them they find a responsible adult, stay for obs or sign ama papers.

 

[Agast]

The best was this old guy who tried to trick us. He was primary caregiver for his wife with dementia so he left her sitting in the waiting area as his “driver,” got his procedure under sedation and then tried to drive the both of them home. This one I put my foot down and made them stay until a daughter took off from work to pick them both up. She was pretty upset with me but I told her frankly her dad tried to trick us and put both of her parents in danger.

 

[coffeebythelake]

The best was this old guy who tried to trick us. He was primary caregiver for his wife with dementia so he left her sitting in the waiting area as his “driver,” got his procedure under sedation and then tried to drive the both of them home. This one I put my foot down and made them stay until a daughter took off from work to pick them both up. She was pretty upset with me but I told her frankly her dad tried to trick us and put both of her parents in danger.

The daughter should be upset at her dad. Not you. You did the absolute right thing.