Practice Guidelines, Managed Care, and Utilization Review
"While you were Wheezing"
After
two albuterol nebulizations in the Emergency Room, Janie has improved. She is afebrile, respiratory rate is 28 per minute, pulse is 100 with 10 mm Hg pulsus
paradoxes. Her lungs have some limited air movement with occasional
end-expiratory wheeze. A pulse ox reading is 96% on room air, up from 92% from
initial reading before treatment. A peak flow meter reading was obtained and is
70% of that which is predicted for her age.
The pediatric resident, Dr. Kilamanjaro, wants to admit Janie to the hospital
because he doesn’t feel the grandmother is capable of delivering adequate care.
They have no home nebulizer, and the E.R. Doctor feels that both Janie and her
grandmother needs "education on asthma management". He also states that he is
afraid that Janie's condition will deteriorate after going home. He writes
admission orders, including a consult to the Asthma Team.
The Admitting Office contacts Dr. Kilamanjaro
to tell him that the Utilization Management Office at Texas Starfighters
does not believe Janie's condition meets the criteria for admission. Dr.
Kilamanjaro calls you (Janie's PCP) at home requesting that you contact,
Texas Starfighters, to "do something" about getting Janie admitted into the
hospital.
Access the UTMB Pediatric Clinical Practice Guidelines website
http://www2.utmb.edu/cpg/ .
Select Asthma Pediatric Emergency
Department Management
for criteria to admit Janie into the hospital.
Can Janie be admitted to the hospital?
Yes
No