Bounceback prevention
Revision as of 11:35, 26 June 2016 by Neil.m.young (talk | contribs) (Text replacement - "==Source==" to "==References== <references/>")
Step 1
Identify High Risk patients:
- High risk complaint without definitive diagnosis on discharge (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 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 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
References
"Bouncebacks" (Weinstock, Longstreth)