Bounceback prevention
(Redirected from Bouncebacks (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)