Bounceback prevention: Difference between revisions
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==Step 1== | ==Step 1== | ||
Identify High Risk patients: | Identify High Risk patients: | ||
*High risk complaint without definitive diagnosis on discharge (eg [[Abdominal Pain]], [[Chest Pain (DDx)|Chest Pain]], [[Headache]], [[Fever]]) | |||
*Abnormal vital signs | |||
*Condition making it less likely patient will return for worsening symptoms (mental/psych/substance abuse) | |||
*Chronic disease with decompensation | |||
*Difficulty obtaining accurate data (language, dementia, inebriation, etc) | |||
*Advanced age | |||
*Upset patient | |||
*Unmet patient expectations | |||
*Bouncebacks (a patient return, usually within 72h) | |||
OVERALL: a | OVERALL: a patient you will worry about after your shift | ||
==Step 2== | ==Step 2== | ||
Review your evaluation prior to | Review your evaluation prior to discharge: | ||
*Address ALL documented complaints in H&P | |||
*Confirm history is accurate | |||
*Consider potentially serious diagnoses | |||
*Explore abnormal findings | |||
*Write a progress note explaining medical decision-making process (if unclear in H&P) | |||
*Assure that aftercare instructions are specific and clear. Ensure follow up schedule is timely and available | |||
*Confirm that patient understands and is comfortable with the plan | |||
OVERALL: Complete a medically and legally defensible eval which is reflected in the documentation on the chart | OVERALL: Complete a medically and legally defensible eval which is reflected in the documentation on the chart | ||
== | ==References== | ||
<references/> | |||
"Bouncebacks" (Weinstock, Longstreth) | "Bouncebacks" (Weinstock, Longstreth) | ||
[[Category:Misc/General]] | [[Category:Misc/General]] | ||
Latest revision as of 09:08, 16 April 2018
Step 1
Identify High Risk patients:
- High risk complaint without definitive diagnosis on discharge (eg Abdominal Pain, Chest Pain, Headache, Fever)
- Abnormal vital signs
- Condition making it less likely patient will return for worsening symptoms (mental/psych/substance abuse)
- Chronic disease with decompensation
- Difficulty obtaining accurate data (language, dementia, inebriation, etc)
- Advanced age
- Upset patient
- Unmet patient expectations
- Bouncebacks (a patient return, usually within 72h)
OVERALL: a patient you will worry about after your shift
Step 2
Review your evaluation prior to discharge:
- Address ALL documented complaints in H&P
- Confirm history is accurate
- Consider potentially serious diagnoses
- Explore abnormal findings
- Write a progress note explaining medical decision-making process (if unclear in H&P)
- Assure that aftercare instructions are specific and clear. Ensure follow up schedule is timely and available
- Confirm that patient understands and is comfortable with the plan
OVERALL: Complete a medically and legally defensible eval which is reflected in the documentation on the chart
References
"Bouncebacks" (Weinstock, Longstreth)