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One emergency physician might feel comfortable giving a medication by injection to a man distraught from hallucinating and in danger of attempting homicide, while another might prefer a psychiatric consultation for almost all of the psychiatric patients seen in the emergency department.
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If a patient comes to a provider asking for a specific name-brand medication, how much weight should the request be given?
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Many pediatricians feel some distress over parents who refuse to vaccinate their children, says Douglas S. Diekema, MD, MPH, attending physician and director of education at the Treuman Katz Center for Pediatric Bioethics at Seattle (WA) Children's Hospital and professor in the Department of Pediatrics at the University of Washington School of Medicine, also in Seattle.
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After interviewing hundreds of patients and family members, a multi-disciplinary team at Kaiser Permanente redesigned the process for transitioning patients from the hospital to home and developed a list of six processes that should happen during every discharge for every patient.
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On any given day, the ED at Mercy Hospital in Springfield, MO, has two zone captains acting as mini-charge nurses, for the east and west sides of the department.
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Aetna's pilot program sending advanced practice nurses into the home of at-risk Medicare patients within seven days of hospital discharge resulted in a 20% decrease in hospital readmissions, over and above the 23% readmission reductions already achieved by the health plan's case management program for Medicare Advantage patients.
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Providers and payers alike are recognizing that ensuring smooth transitions when patients move between levels of care and implementing projects to help transitioning patients avoid an emergency room visit or a hospital readmission is the right thing to do.
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Kaiser Permanente's six-step process to improve transitions of care has resulted in reduced preventive hospital readmissions, an increase in the percentage of patients with physician appointments within five days of discharge, and raised patient satisfaction scores.
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To prevent readmissions when patients are transitioning from the acute care hospital to an inpatient rehabilitation center, case managers should make sure the patients are appropriate for acute rehab, that their medical conditions are stable, and that they can tolerate three hours of therapy every day.
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Every now and then at Sunnybrook Health Sciences in Toronto, Canada, there was talk about getting ventilated patients up and about even if they were still intubated. Some people thought that the patients should be weaned off the ventilator first, some thought after, says Linda Nusdorfer, RN, MSN, an advanced practice nurse for critical care and cardiovascular care at the facility. Still others wanted to work on weaning and mobility at the same time.
