It’s 11:00 AM at a busy 150-bed hospital in Bangalore.

Nurse Priya receives a discharge order for Bed 304—a 62-year-old patient recovering from knee replacement surgery. Medically cleared. Ready to go home.

What should take 90 minutes will stretch until after 4 PM.

Here’s what the next five hours look like.

11:15 AM – Calls billing. No answer. Walks to the 3rd-floor billing office.
11:40 AM – Billing says TPA approval is pending. Calls insurance desk. On hold for 12 minutes.
12:00 PM – Walks to pharmacy (Building B). Discharge medications weren’t notified yet.
12:30 PM – Calls equipment room for a wheelchair. “We’ll send someone.” No one comes.
1:15 PM – Patient’s son calls the nurse station asking for an update. Priya doesn’t have one.
1:45 PM – Billing finally clears. She walks back to pharmacy to expedite medicines.
2:30 PM – Still no wheelchair. Priya walks to the basement equipment room herself.
3:15 PM – Discharge summary still unsigned. The resident doctor is in OT.
3:45 PM – Family arrives. Medications ready. Wheelchair ready. Waiting for the doctor.
4:10 PM – Patient finally leaves.

Total: 5 hours, 12 phone calls, and over 2 kilometers walked inside the hospital.

Priya returns to her station exhausted. She has six other patients who needed her attention today. She barely saw them.

This is not a Priya problem.
This is a system failure.

Why Nurses Become the Coordination Hub by Default

Ask a simple question inside most hospitals:

“Who owns the discharge?”

You’ll get different answers:

“The doctor writes the order.”
“Case management handles discharge.”
“The ward nurse coordinates.”
“It’s a team effort.”

When everyone is responsible, no one is accountable.

Here’s what actually happens:

The doctor writes the discharge order and moves on.
The case manager (if one exists) focuses on insurance, not logistics.
Billing doesn’t know a discharge is planned until someone calls.
Pharmacy waits for verbal confirmation because orders get cancelled.
Equipment works first-come-first-served, with no urgency visibility.
Families call the nurse station every 30 minutes asking, “Can we come?”

The only person seeing the full picture is the bedside nurse—because she is manually stitching it together.

So coordination collapses onto her.

Information Doesn’t Flow. It Has to Be Chased.

In a typical hospital, this is how discharge coordination really works:

Doctor → Nurse: EMR order + verbal handoff
Nurse → Billing: Phone call (often multiple attempts)
Nurse → Pharmacy: Phone call or handwritten slip
Nurse → Transport/Equipment: WhatsApp group message
Nurse → Family: Repeated phone calls

Each handoff is manual.
Each delay needs follow-up.
Each follow-up pulls the nurse away from patient care.

Meanwhile:

Billing doesn’t know the patient is medically cleared
Pharmacy doesn’t know billing is waiting on TPA
Transport doesn’t know medicines aren’t ready
Family doesn’t know anything until they arrive

Everyone is working in isolation.
The nurse is the only integration layer.

Every Department Uses a Different System

Walk through the hospital and ask:

Doctors: “We use the EMR.”
Nurses: “EMR, WhatsApp, phone calls.”
Billing: “Tally and a billing system.”
Pharmacy: “Pharmacy software, mostly phone.”
Transport/Equipment: “WhatsApp group and a register.”
Families: “We call the nurse station.”

The nurse becomes the human API:

Logging into systems she doesn’t own
Calling departments she doesn’t control
Tracking progress in her head or on paper

This isn’t coordination.
It’s heroic effort masking structural dysfunction.

The Hidden Costs of This Failure

For Nurses: Burnout from Coordination Overload

Studies in Indian hospitals show nurses spend 35–45% of their shift on coordination—not care.

That’s 3–4 hours per shift spent:

Walking between departments
Making follow-up calls
Managing interruptions
Handling frustration they didn’t create

Burnout rises. Engagement drops. Good nurses leave—not because of patients, but because of systems.

For Hospitals: Lost Revenue and Blocked Beds

For a 100-bed hospital:

Average discharge time: 5–6 hours
Optimal discharge time: ~90 minutes
Time wasted per discharge: ~4 hours

If 30 beds turn over daily:

120 bed-hours lost per day
Equivalent to 5 blocked beds

Annual impact:

~1,277 bed-days lost
At ₹8,000 per bed-day → ₹1+ crore annually

And that excludes:

Nurse overtime
Delayed billing collections
Reputation damage

For Patients and Families: Frustration and Risk

From the patient’s perspective:

“You’re going home today” at 9 AM
Still waiting at 3 PM
Family loses a workday
Anxiety builds
Infection risk increases

Clinical care may be excellent—but the experience feels chaotic.

Why Common Fixes Don’t Work

“Hire more discharge coordinators”
Adds cost, not flow. Still manual. Still blind.

“Use the EMR for coordination”
EMRs are systems of record, not systems of action:

Desktop-first
Limited access
No real-time nudging or escalation

“Create WhatsApp groups”
Unstructured chat creates noise, not accountability.
Messages get lost. Ownership is unclear. Nothing closes cleanly.

WhatsApp groups create the illusion of coordination.

What a System-Level Solution Looks Like

A real solution does three things:

1. Information Moves Automatically

Discharge order → instant notifications to billing, pharmacy, equipment, family—without nurse chasing.

2. People Use Tools They Already Have

No new apps. No training. WhatsApp becomes the action surface, not the memory.

3. Accountability Is Built In

Clear owners. SLAs. Auto-escalation. Shared visibility.

The nurse monitors progress instead of driving it.

The Shift Hospitals Must Make

The question isn’t:

“Why are nurses always chasing?”

It’s:

“Why does our system require them to?”

Until coordination is owned by the system, nurses will keep compensating—quietly, exhaustingly, and unsustainably.

Fix the system, and nurses go back to what they’re trained for: caring for patients.

Why Nurses End Up Chasing Everyone During Discharge — And Why That's a System Failure