Bounceback prevention

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)