Practice Guidelines, Managed Care, and Utilization Review
"While you were Wheezing"
Janie most likely does not meet criteria for ‘full
admission” to the hospital. She has clinically improved since her arrival at the
emergency room. Her oxygen saturation is above 95%, PFER is 70% normal,
wheezing has improved and she does no have a significant pulsus paradoxus.
On
the other hand, her physician in the ER is nervous about sending her home.
Janie was very sick just a short time before. There is no nebulizer at home,
and Dr. Kilimanjaro is not comfortable that Janie’s grandmother understand how
to assess, or monitor her condition.
Admit Janie and then justify your actions later because this is a teaching hospital and we need cases like this to teach our Residents and Students.
Janie should be admitted for 1-23 hours observation if the clinical situation warrants.
Involve the ER Social Worker in obtaining a nebulizer machine to be delivered from the preferred vendor for durable medical equipment to the patient's home later that same day.