Bounceback prevention

Step 1

Identify High Risk patients:

1. High risk complaint without definitive diagnosis on d/c (eg Abdominal Pain, Chest Pain, Headache, Fever)
2. Abnl VS
3. Condition making it less likely pt will return for worsening symptoms (mental/psych/substance abuse)
4. Chronic dz with decompensation
5. Difficulty obtaining accurate data (language, dementia, inebriation, etc)
6. Advanced age
7. Upset pt
8. Unmet pt expectations
9. 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:

1. Address ALL documented complaints in H&P
2. Confirm hx is accurate
3. Consider potentially serious dx
4. Explore abnl findings
5. Write a progress note explaining medical decision-making process (if unclear in H&P)
6. Assure that aftercare instructions are specific and f/u is timely and available
7. 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)