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 d/c (eg [[Abdominal Pain]], [[Chest Pain (DDx)|Chest Pain]], [[Headache]], [[Fever]]) | |||
*Abnl VS | |||
*Condition making it less likely pt will return for worsening symptoms (mental/psych/substance abuse) | |||
*Chronic dz with decompensation | |||
*Difficulty obtaining accurate data (language, dementia, inebriation, etc) | |||
*Advanced age | |||
*Upset pt | |||
*Unmet pt expectations | |||
*Bouncebacks (a pt return, us within 72h) | |||
OVERALL: a pt you will worry about after your shift | OVERALL: a pt you will worry about after your shift | ||
| Line 15: | Line 15: | ||
==Step 2== | ==Step 2== | ||
Review your evaluation prior to d/c: | Review your evaluation prior to d/c: | ||
*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 pt 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 | ||
Revision as of 06:45, 30 August 2015
Step 1
Identify High Risk patients:
- High risk complaint without definitive diagnosis on d/c (eg Abdominal Pain, Chest Pain, Headache, Fever)
- Abnl VS
- Condition making it less likely pt will return for worsening symptoms (mental/psych/substance abuse)
- Chronic dz with decompensation
- Difficulty obtaining accurate data (language, dementia, inebriation, etc)
- Advanced age
- Upset pt
- Unmet pt expectations
- Bouncebacks (a pt return, us within 72h)
OVERALL: a pt you will worry about after your shift
Step 2
Review your evaluation prior to d/c:
- 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 pt understands and is comfortable with the plan
OVERALL: Complete a medically and legally defensible eval which is reflected in the documentation on the chart
Source
"Bouncebacks" (Weinstock, Longstreth)