Bounceback prevention

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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 follow up 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)