Bounceback prevention: Difference between revisions
Neil.m.young (talk | contribs) (Text replacement - " pt " to " patient ") |
ClaireLewis (talk | contribs) (→Step 1) |
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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]]) | *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) | *Condition making it less likely patient will return for worsening symptoms (mental/psych/substance abuse) | ||
*Chronic | *Chronic disease with decompensation | ||
*Difficulty obtaining accurate data (language, dementia, inebriation, etc) | *Difficulty obtaining accurate data (language, dementia, inebriation, etc) | ||
*Advanced age | *Advanced age | ||
*Upset | *Upset patient | ||
*Unmet patient expectations | *Unmet patient expectations | ||
*Bouncebacks (a patient return, | *Bouncebacks (a patient return, usually within 72h) | ||
OVERALL: a patient you will worry about after your shift | OVERALL: a patient you will worry about after your shift | ||
Revision as of 19:38, 12 July 2016
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 hx is accurate
- Consider potentially serious dx
- Explore abnl findings
- Write a progress note explaining medical decision-making process (if unclear in H&P)
- Assure that aftercare instructions are specific and f/u 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)