Medicare's end-of-life counseling policy may find acceptance

[Threegoofs]

You probably should rethink the whole - "it won't cost anything to admit her to hospital except clean sheets" stuff. I'm sure it doesn't work in your businesses. Heck, what are the marginal costs of another MRI? Some electricity and computer storage space? Why not give them away for that - $5 or $10 each?

And I don't know the details of those cases but it seems to me you're describing the inevitable tensions of healthcare between providing the level of care the patient and his or her advocates want/expect/demand, versus the reality that we cannot afford to provide that level of care. We're living it right now with my mother in law who's living with us while she had and is now recovering from a total hip. The discharge from the hospital and from inpatient rehab has seemed rushed from our perspective, but the reality of it is the level of care she got was probably appropriate given the fact that inpatient care, in hospital or in rehab, is very costly and so she was discharged when she could be, although it wasn't fun for her or us.

I will say we've experienced with her and my father in law some pretty amazing incompetence in the healthcare system where they live. In my city, it's been outstanding. I'm not sure if that relates to incentives in the system or not, but I don't see how. From where I sit it appears that living in a regional healthcare hub has fostered a lot of competition between providers and raised the overall level of care.

You're talking to a guy who makes his money by pushing for excessive care.

Why do you think PT places are opening in every mini mall? Highly profitable to get insurance to pay for your gym.

 

[JasperL]

Of course because in the example of the lady with the broken arm.. it WAS a trivial expenditure,... you were the one that broke out "well why not MRI's" yada yada.

No, sorry, but a night in the hospital costs a lot of money. You've assumed an open bed, and allocated none of the immense fixed costs associated with providing that bed all the equipment and real property and fixed assets for her and millions more "just one night, what the big deal??!!" beds to patients per year. It's a simplistic way to look at it. The hospital has to recover those costs and if the hospital doesn't recover the costs from that patient, they'll have to collect more from the rest of their patients to break even.

Well.. for one.. I didn't say it "anything more than a cost of sheets".. now did I? Hey.. lets not go down this road of you realizing I am once again right but trying to find some way to try and score points.
and for this person.. yeah it didn't have much cost.

LOL, I don't realize you're right, and I'm not trying to "score points." I'm making an honest attempt at a reasonable conversation, and not accusing YOU of bad faith....

Well and there you have why we spend so much in healthcare in the us.. and why we are so terrible in preventative medicine.

Factor this in.. lets say that the extra 30 patients you admit adds another group of nurses to hold over. So that night.. until the next shift where they can be discharged. So we are talking night shift and morning.
30 patients.. so lets factor 5 patients per nurse average (and quite frankly since these folks are "might be's.. it probably could be a lot more per nurse).
6 more nurses, two shifts.. so 12 nurses.. x 16 hours (two shifts). Lets say average 30 dollars an hour per nurse (quite high).

Etc.... omitted for brevity

Frankly I don't know if you're right. I certainly agree that there is a possibility that better preventive care and all the rest will save money long term. But you're really not getting us there at all. You've got a wing in a hospital adding costs roughly equal to the salaries of a nursing crew. And your costs savings are clearly the full costs of treating the injuries prevented, which will include all the allocated fixed and variable costs the hospital has to recover from each patient. It's apples to oranges.

No.. I am not making that argument that that's why hospitals do it. they do it because the system rewards them financially for doing it.. lower admissions.. less readmissions, shorter lengths of stay, dc to lower level of care and so on.. all make the hospital more money. And of course.. its done in the name of "tough choices to keep costs down"..
but as I point out..the "tough choice" to send grandma home when she has just fallen and broken her arm.. when her balance, and shoulder repair options have not been fully evaluated. Really doesn't save any money but can end up costing thousands upon thousands more. The actual cost of keeping 100 of those grandmas.. is outweighed by the savings if you prevent one of those hundred from falling and fracturing a hip, or having adhesive capsulitis.

But our system.. our very way of thinking is not geared to think like that..

I'm not trying to be disagreeable, but our system has worked that way forever. I've read papers on infections and the sad truth is hospitals apparently still profit from giving their patients infections. I am sure they don't try but don't have the financial incentives.

 

[jaeger19]

No, sorry, but a night in the hospital costs a lot of money. You've assumed an open bed, and allocated none of the immense fixed costs associated with providing that bed all the equipment and real property and fixed assets for her and millions more "just one night, what the big deal??!!" beds to patients per year. It's a simplistic way to look at it. The hospital has to recover those costs and if the hospital doesn't recover the costs from that patient, they'll have to collect more from the rest of their patients to break even.

The bed was already there. So whether she was in it.. or was not in it.. those costs were already there Jasper.
Come now.. you are now being silly.

LOL, I don't realize you're right, and I'm not trying to "score points." I'm making an honest attempt at a reasonable conversation, and not accusing YOU of bad faith....

You mean honest by boiling my premise to "just sheets"? You mean that honesty?

Frankly I don't know if you're right. I certainly agree that there is a possibility that better preventive care and all the rest will save money long term. But you're really not getting us there at all. You've got a wing in a hospital adding costs roughly equal to the salaries of a nursing crew. And your costs savings are clearly the full costs of treating the injuries prevented, which will include all the allocated fixed and variable costs the hospital has to recover from each patient. It's apples to oranges

Not quite... of preventing ONE of those thirty questionable patients from having say a fall..
That's the point. Just one.. and you break even or still do better. Now two.. or three of those questionable patients... and the savings is way more than the cost. But you bring up an interesting subject...

so okay.. how would YOU calculate the savings of preventative medicine?

I'm not trying to be disagreeable, but our system has worked that way forever. I've read papers on infections and the sad truth is hospitals apparently still profit from giving their patients infections. I am sure they don't try but don't have the financial incentives.

Being disagreeable? To who? ME? You are agreeing with exactly what I have been saying...

Now let me put it in better perspective. Hospitals don't profit from giving their patients infections. In fact they lose money by giving their patients infections. But here is the issue. The hospital bean counters and administration often goes through the SAME though process as you did when talking about admitting a questionable patient.

Lets say that if we instituted a better sterilization technique and added technology to our surgical suites that we would reduce infections within the hospital. Why do it?

Is there any PROOF that the infection started in Surgery? No because the patient didn't show signs of infection until they had been already on the floor and not every patient in surgery got it..

So here is hospital administration.. looking at very real costs to implement those changes.. and for what? A maybe? And how much savings? and better yet.. how do I justify it to the board?

Our culture. including our community culture is not able to see the forest because of the expensive tree.

 

[Threegoofs]

The bed was already there. So whether she was in it.. or was not in it.. those costs were already there Jasper.
Come now.. you are now being silly.



You mean honest by boiling my premise to "just sheets"? You mean that honesty?



Not quite... of preventing ONE of those thirty questionable patients from having say a fall..
That's the point. Just one.. and you break even or still do better. Now two.. or three of those questionable patients... and the savings is way more than the cost. But you bring up an interesting subject...

so okay.. how would YOU calculate the savings of preventative medicine?



Being disagreeable? To who? ME? You are agreeing with exactly what I have been saying...

Now let me put it in better perspective. Hospitals don't profit from giving their patients infections. In fact they lose money by giving their patients infections. But here is the issue. The hospital bean counters and administration often goes through the SAME though process as you did when talking about admitting a questionable patient.

Lets say that if we instituted a better sterilization technique and added technology to our surgical suites that we would reduce infections within the hospital. Why do it?

Is there any PROOF that the infection started in Surgery? No because the patient didn't show signs of infection until they had been already on the floor and not every patient in surgery got it..

So here is hospital administration.. looking at very real costs to implement those changes.. and for what? A maybe? And how much savings? and better yet.. how do I justify it to the board?

Our culture. including our community culture is not able to see the forest because of the expensive tree.

This dismissal of hospital costs is just absurd.

The nurse isnt already there. Nurses are staffed based on ratios to patients. If you increase admissions more (if you admit this lady, you admit x% more on average), you increase staffing. Thats nursing staffing. You then dismiss the pharmacy cost. You know the staffing it requires for pharmacy? You have a pharmacist, a tech or two, someone to make a med cart, fill the med cart, run the med cart to the floor, etc. Repeat the same for lab. Repeat the same for housekeeping. etc.

And for this admission, the entire reason you seem to want to put her in the hospital is so she can be assesed by an ortho and (naturally, in your case) OT and PT.

Well, that assessment can be done quite easily as an outpatient, and usually a surgical referral will not be in a matter of weeks, but days.

Is this inconvenient for the patient and caregiver? yes. But making things convenient costs money, and thats what we are trying to save here.

The care sounds like it was quite appropriate, and the caregiver is complaining its hard, which it is. But a hospital is there to give good care, not to make things easy. Its why we dont keep people in house for three weeks after a fracture anymore.

 

[jaeger19]

This dismissal of hospital costs is just absurd.

The nurse isnt already there. Nurses are staffed based on ratios to patients. If you increase admissions more (if you admit this lady, you admit x% more on average), you increase staffing. Thats nursing staffing. You then dismiss the pharmacy cost. You know the staffing it requires for pharmacy? You have a pharmacist, a tech or two, someone to make a med cart, fill the med cart, run the med cart to the floor, etc. Repeat the same for lab. Repeat the same for housekeeping. etc.

And for this admission, the entire reason you seem to want to put her in the hospital is so she can be assesed by an ortho and (naturally, in your case) OT and PT.

Well, that assessment can be done quite easily as an outpatient, and usually a surgical referral will not be in a matter of weeks, but days.

Is this inconvenient for the patient and caregiver? yes. But making things convenient costs money, and thats what we are trying to save here.

The care sounds like it was quite appropriate, and the caregiver is complaining its hard, which it is. But a hospital is there to give good care, not to make things easy. Its why we dont keep people in house for three weeks after a fracture anymore.

Already addressed that Three goofs.. keep up.

And the assessment by a PT (in her case an OT would not really be needed)... would be to determine if she would BE SAFE TO GO HOME.

So your suggestion is that we send her home and then send a PT to find out if she is safe to be home? WOW.. .

And we aren't talking about making things easy.. we are talking about preventing falls and further complications...which would reduce overall costs to the healthcare system.

Isn't that what is supposed to be the issue?

 

[Threegoofs]

Already addressed that Three goofs.. keep up.

And the assessment by a PT (in her case an OT would not really be needed)... would be to determine if she would BE SAFE TO GO HOME.

So your suggestion is that we send her home and then send a PT to find out if she is safe to be home? WOW.. .

And we aren't talking about making things easy.. we are talking about preventing falls and further complications...which would reduce overall costs to the healthcare system.

Isn't that what is supposed to be the issue?

So where in the original issue was that it was not safe for her to go home? She didnt fall. There was no indication of safety as a concern. There also seemed to be no complications.

So every patient going thru the ED needs to get admitted and a PT has to look at her and certify them as safe to go home? How much is your cut from each of these consults? Is the ER staff completely unqualified to make that determination? If so, why isnt a PT assigned to the ED to minimize costly hospitalizations for ED docs and nurses admitting everyone in sight because they cant see if a patient can sit in a wheelchair and bring a spoon to their mouth with their good hand.

 

[JasperL]

The bed was already there. So whether she was in it.. or was not in it.. those costs were already there Jasper.
Come now.. you are now being silly.

You can't run a hospital assuming the only cost for a room are the variable costs of the direct staff on the floor. Give me a break. What you're suggesting is there is always a surplus of beds, and we can change the system to admit a bunch more marginal patients "just one night" and that surplus persists and we can admit a bunch of "just one night" patients without needing a new wing, a new hospital over time, $10s or $100s of millions in costs, etc.

And of course you ignored the point that you're costing the savings as full costs of treating e.g. a hip, but assuming the costs of avoiding that hip are the low variable costs. It's a nice and bogus way to manipulate the facts in your favor.

You mean honest by boiling my premise to "just sheets"? You mean that honesty?

You're right, I forgot the breakfast, quoting you: #83

So gee.. what would the COST of admitting her actually been? Lets see.. clean sheets, and possibly breakfast? And a PT consult.

Yes, you added a few later. Still woefully inadequate.

Now let me put it in better perspective. Hospitals don't profit from giving their patients infections. In fact they lose money by giving their patients infections. But here is the issue. The hospital bean counters and administration often goes through the SAME though process as you did when talking about admitting a questionable patient.

Lets say that if we instituted a better sterilization technique and added technology to our surgical suites that we would reduce infections within the hospital. Why do it?

Is there any PROOF that the infection started in Surgery? No because the patient didn't show signs of infection until they had been already on the floor and not every patient in surgery got it.

So here is hospital administration.. looking at very real costs to implement those changes.. and for what? A maybe? And how much savings? and better yet.. how do I justify it to the board?

Our culture. including our community culture is not able to see the forest because of the expensive tree.

I've read papers by people pretty involved in the process and their claim is the fact that hospitals charge a lot of money to treat infections that at best there is little to no financial incentive to prevent them.

I'll address some of the rest later..

 

[Threegoofs]

Actually, there now is a strong incentive to prevent hospital acquired infections- the HEDIS measures highlight them as a quality measure in hospitals, which will affect reimbursement.

Implementation of the ACA is driving these infections down.

HACs Decline by 17% | Agency for Healthcare Research & Quality (AHRQ)

Once again.... Thanks, Obama!

 

[jaeger19]

So where in the original issue was that it was not safe for her to go home? She didnt fall. There was no indication of safety as a concern. There also seemed to be no complications.

So every patient going thru the ED needs to get admitted and a PT has to look at her and certify them as safe to go home? How much is your cut from each of these consults? Is the ER staff completely unqualified to make that determination? If so, why isnt a PT assigned to the ED to minimize costly hospitalizations for ED docs and nurses admitting everyone in sight because they cant see if a patient can sit in a wheelchair and bring a spoon to their mouth with their good hand.

There was no fall? How did she break her arm? Its been a while. but I figure she must have had a fall or some such to break her shoulder? Was she doing MMA and blocked a kick?

So every patient going thru the ED needs to get admitted and a PT has to look at her and certify them as safe to go home?

Really? What lengths of BS doing you really want to go through here? Come now. Of course not every patient. An elderly woman that falls and breaks and arm, is going to be on placed on pain medications? Yeah.. maybe it would be smart to do a balance assessment and functional screen to see if she should be discharged to home. Pretty easy stuff.

Is the ER staff completely unqualified to make that determination

? No.. a doctor could do it. If they had the time.. and of course it would be a delay because you would need to see how she was with her pain controlled (which would take a while).

If so, why isnt a PT assigned to the ED to minimize costly hospitalizations for ED docs and nurses admitting everyone in sight because they cant see if a patient can sit in a wheelchair and bring a spoon to their mouth with their good hand.

We actually routinely call PT into the ER on those questionable cases... and if it happen on the evening or night shift.. either the patient is kept in observation and the PT and ortho would see the patient the next morning.. or they are admitted depending on the physicians and nurses call.

its worked out well in reducing readmissions and in public satisfaction of our services. In our competitive markets.. that means a lot since it attracts a better payer mix and payer mix is everything.

 

[jaeger19]

You can't run a hospital assuming the only cost for a room are the variable costs of the direct staff on the floor. Give me a break. What you're suggesting is there is always a surplus of beds, and we can change the system to admit a bunch more marginal patients "just one night" and that surplus persists and we can admit a bunch of "just one night" patients without needing a new wing, a new hospital over time, $10s or $100s of millions in costs, etc.

First off...do you have any idea what the national average hospital occupancy rate is?

National average hospital bed occupancy rate (2012): 61 percent.
Number of beds available (per 1,000 people, 2012) 2.6 beds.
Occupancy rate for urban hospitals (2012): 64 percent.
Occupancy rate for rural hospitals (2012): 43 percent

Yeah man.. you got me.. better not admit Grandma with a broken arm because we will need a whole new hospital!. Jeez Louise man!.

All right. You have a 100 bed urban hospital that you built and paid for 5 years ago. you have an average occupancy of 61 percent or 61 people. NOW you explain to me how you are saving on your FIXED construction costs.. by denying this lady a bed.
Seriously,, I want to hear it.

And of course you ignored the point that you're costing the savings as full costs of treating e.g. a hip, but assuming the costs of avoiding that hip are the low variable costs. It's a nice and bogus way to manipulate the facts in your favor.

See above. I want you to justify by savings of fixed costs.. NOT admitting her to a bed when there is 29 beds available. Compared to the savings by preventing a fall.

Yes, you added a few later. Still woefully inadequate.

BULL. But you go ahead... you do what I asked above... I want you to calculate exactly the costs involved with admitting her since you know oh so much more than me about the hospital industry that I am a part of.
And then you compare that to the costs if we have to admit her with a subcapital fracture.. or broken pelvis.

 

[jaeger19]

I've read papers by people pretty involved in the process and their claim is the fact that hospitals charge a lot of money to treat infections that at best there is little to no financial incentive to prevent them.

Well then they would be wrong. Since the advent of the DRG that has been cost controls on iatrogenic infections. In 2006 there was strengthening of these cost controls

On February 8, 2006, the President signed the Deficit Reduction Act (DRA) of 2005. Section 5001(c) of DRA requires the Secretary to identify conditions that are: (a) high cost or high volume or both, (b) result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been prevented through the application of evidence-based guidelines. Section 5001(c) provides that CMS can revise the list of conditions from time to time, as long as it contains at least two conditions. The statute is available in the Statute/Regulations/Program Instructions section, accessible through the navigation menu at left.


For discharges occurring on or after October 1, 2008, hospitals will not receive additional payment for cases in which one of the selected conditions was not present on admission. That is, the case would be paid as though the secondary diagnosis were not present.

NOW.. that has been further strengthened under the ACA

The Hospital-Acquired Condition (HAC) Reduction Program is the newest effort under the Affordable Care Act that builds on the progress of reducing hospital acquired conditions achieved through the existing HAC program established under the Deficit Reduction Act (DRA) of 2005. The DRA HAC program currently saves the Medicare program approximately $30 million annually. These savings are the result of not providing additional Medicare payment for treatment of certain reasonably preventable conditions when those conditions are acquired after the beneficiary has been admitted to the hospital.

The HAC Reduction Program uses public reporting and financial incentives to encourage Inpatient Prospective Payment System hospitals to reduce HACs and improve patient safety. The HACs, which are specified in rulemaking by the Centers for Medicare & Medicaid Services (CMS) each year, are a group of reasonably preventable conditions, including infections, that patients did not have upon admission to a hospital, but which developed during the hospital stay. The HAC Reduction Program builds on the Administration’s efforts to achieve better patient outcomes while slowing health care cost growth.

 

[Threegoofs]

There was no fall? How did she break her arm? Its been a while. but I figure she must have had a fall or some such to break her shoulder? Was she doing MMA and blocked a kick?



Really? What lengths of BS doing you really want to go through here? Come now. Of course not every patient. An elderly woman that falls and breaks and arm, is going to be on placed on pain medications? Yeah.. maybe it would be smart to do a balance assessment and functional screen to see if she should be discharged to home. Pretty easy stuff.

? No.. a doctor could do it. If they had the time.. and of course it would be a delay because you would need to see how she was with her pain controlled (which would take a while).



We actually routinely call PT into the ER on those questionable cases... and if it happen on the evening or night shift.. either the patient is kept in observation and the PT and ortho would see the patient the next morning.. or they are admitted depending on the physicians and nurses call.

its worked out well in reducing readmissions and in public satisfaction of our services. In our competitive markets.. that means a lot since it attracts a better payer mix and payer mix is everything.

She didn't fall after the break. The ED obviously assessed her as competent to go home.

The system worked, and was done at a lower cost by saving a hospital admission.

 

[JasperL]

Well then they would be wrong. Since the advent of the DRG that has been cost controls on iatrogenic infections. In 2006 there was strengthening of these cost controls

I'm just reading the studies, which consider the Medicare DRGs and private insurance, private pay. This is one: Doing well by doing good: assessing the cost savings of an intervention to reduce central line-associated bloodstream infections in a Hawaii hospital. - PubMed - NCBI

A complete understanding of the financial impact of patient safety interventions must consider the economic incentives of both payers and providers within the current fee-for-service payment model. This study evaluated the impact of a central line-associated bloodstream infection (CLABSI) initiative on costs, reimbursements, and margins for 1 Hawaii hospital and its payers. Intensive care unit patients (January 2009-December 2011) who developed a CLABSI were compared to matched controls. Mean hospital cost, reimbursement, and margin was $222 692 versus $80 144 (P = .01), $259 433 versus $72 543 (P < .01), and $54 906 versus $6506 (P < .01), respectively. Although hospitals and payers reduce costs by preventing CLABSIs, hospitals also would decrease their margins, which creates a perverse incentive to have more line infections.

The key stat is the last one - hospital margins on a patient getting an infection were 55k versus 6.5k if no infection. If you've got some evidence the programs have worked to eliminate the incentives, I'd love to see the citation.

 

[jaeger19]

She didn't fall after the break. The ED obviously assessed her as competent to go home.

The system worked, and was done at a lower cost by saving a hospital admission.

She fell before the break didn't she? that's the point...


The ED may not have assessed her but simply got lucky.

Obviously she is having issues or her son wouldn't be complaining about the discharge now would he?

Or I guess the son and mothers experience don't matter as long as you can support your agenda.

 

[jaeger19]

I'm just reading the studies, which consider the Medicare DRGs and private insurance, private pay. This is one: Doing well by doing good: assessing the cost savings of an intervention to reduce central line-associated bloodstream infections in a Hawaii hospital. - PubMed - NCBI



The key stat is the last one - hospital margins on a patient getting an infection were 55k versus 6.5k if no infection. If you've got some evidence the programs have worked to eliminate the incentives, I'd love to see the citation.

Something doesn't fit because intensive care unit is not a fee for service model. Its a prospective payment system.

 

[Threegoofs]

She fell before the break didn't she? that's the point...


The ED may not have assessed her but simply got lucky.

Obviously she is having issues or her son wouldn't be complaining about the discharge now would he?

Or I guess the son and mothers experience don't matter as long as you can support your agenda.

In other words, you have no idea what the ED did, and just assume they discharge patients out after a fall without assessing how much at risk they are... which again, would be malpractice.

You must not really be in patient care. Family members complain all the time about everything and anything.

Not sure what you think my agenda is....

 

[jaeger19]

In other words, you have no idea what the ED did, and just assume they discharge patients out after a fall without assessing how much at risk they are... which again, would be malpractice.

You must not really be in patient care. Family members complain all the time about everything and anything.

Not sure what you think my agenda is....

In other words.. I know that the patient fell, and the family felt that she was discharged inappropriately that she apparently still has difficulties using her arm.. is possibly heading toward adhesive capsulitis, may be headed toward another fall (because of continued pain and use of pain medications), and may be headed toward failure to thrive from not eating well and possibly another admission...



In my experience of working in the medical field for over 20 years... its imperative that providers listen to patients and their families as its a very rare patient that has complaints for no good reason.

 

[Threegoofs]

In other words.. I know that the patient fell, and the family felt that she was discharged inappropriately that she apparently still has difficulties using her arm.. is possibly heading toward adhesive capsulitis, may be headed toward another fall (because of continued pain and use of pain medications), and may be headed toward failure to thrive from not eating well and possibly another admission...



In my experience of working in the medical field for over 20 years... its imperative that providers listen to patients and their families as its a very rare patient that has complaints for no good reason.

In other words, you dont know.

Its either malpractice or they did it. I generally lean to the side that health care professionals usually act in the most appropriate manner. And I certainly would hope that an elderly woman with a bad arm would have trouble using it. In the absence of any of the other evidence, I'd have to assume that the ED did it correctly, and your speculation is about as valid as saying the patient has an osteosarcoma and is at risk for multiple other fractures and will die in weeks without chemotherapy.

 

[jaeger19]

Something doesn't fit because intensive care unit is not a fee for service model. Its a prospective payment system.

Got it:

For cases with no outlier the hospital had a decreased margin for cases, and for cases with outliers the hospital had an increased margin. Close to three quarters of cases resulted in outlier payments compared with slightly less than half of controls. For government payers, the hospital experienced a greater financial loss for cases compared to controls.

So.. creating an infection cost the hospital money... except when the hospital has outliers that cost too much money then they get a bump in outlier pay. Which is problematic to say that "hospitals have an incentive to create infections"... because by having outlier pay to pay for patients that have exceeded their costs under the prospective payment system.. it would not be just about infections but basically having any complicated case would be advantageous as long as the hospital COULD PREDICT which ones would reach that threshold.

For government payers, the hospital experienced a greater financial loss for cases compared to controls.

So... for government payers.. the hospital had a financial loss.

Now. besides the fact that the study had a very small population (n=16)..

one of the confounding variables in this is that patients that ended up with an infection.. (and more likely to be an outlier) also had higher comorbidity on admission.

The mean Charlson–Deyo comorbidity score for CLABSI cases was 3.12 compared to 2.74 in controls (P = .25), suggesting that CLABSI patients had higher comorbidities at baseline

SO the CLABSI class of patients would with more comorbidities... accounted for more likely to reach an outlier..

Doing Well by Doing Good

 

[jaeger19]

In other words, you dont know.

Its either malpractice or they did it. I generally lean to the side that health care professionals usually act in the most appropriate manner. And I certainly would hope that an elderly woman with a bad arm would have trouble using it. In the absence of any of the other evidence, I'd have to assume that the ED did it correctly, and your speculation is about as valid as saying the patient has an osteosarcoma and is at risk for multiple other fractures and will die in weeks without chemotherapy.

Except that you ignore that the patient's family relates problems that indicate that the discharge was not in the most appropriate manner. I take into account the perspective from the family of the patients continued problems.

My speculation is based on the family members observations of her progress, continued pain and dysfunction. Not on a simple.. you have an osteosarcoma.

But of course.. you disregard the patient and family's comments because "they complain about anything and everything"...

sorry but you tipped your hand there. :shock:

 

[Threegoofs]

Except that you ignore that the patient's family relates problems that indicate that the discharge was not in the most appropriate manner. I take into account the perspective from the family of the patients continued problems.

My speculation is based on the family members observations of her progress, continued pain and dysfunction. Not on a simple.. you have an osteosarcoma.

But of course.. you disregard the patient and family's comments because "they complain about anything and everything"...

sorry but you tipped your hand there. :shock:

Family members complaining that taking care of an elderly person is hard is not a reason for hospital admission. (although sometimes, if the family is a real PITA, we will do it because they show themselves to be unreliable).

 

[jaeger19]

Family members complaining that taking care of an elderly person is hard is not a reason for hospital admission. (although sometimes, if the family is a real PITA, we will do it because they show themselves to be unreliable).

Family members complaining that their loved one is still in terrible pain.. cannot use their affected limb, and are not thriving, and are regressing physically ARE reasons for a hospital admission.

 

[Threegoofs]

Family members complaining that their loved one is still in terrible pain.. cannot use their affected limb, and are not thriving, and are regressing physically ARE reasons for a hospital admission.

No. Terrible pain, non use of a limb and physical regression are reasons for an evaluation.

Pain can be treated as an outpatient. PT can be prescribed as an outpatient. Physical regression doesn't magically disappear in a hospital bed.

 

[jaeger19]

No. Terrible pain, non use of a limb and physical regression are reasons for an evaluation.

Pain can be treated as an outpatient. PT can be prescribed as an outpatient. Physical regression doesn't magically disappear in a hospital bed.

I see... so if you develop terrible pain in your left arm, start having difficulty using that arm and are physically weak on a weekend.. you will decide to wait until Monday to trot down to the doctors office.. rather than go to the ER....:roll:

I suggest you don't.


Seriously man.. you are just digging your hole deeper. But whatever.

 

[Threegoofs]

I see... so if you develop terrible pain in your left arm, start having difficulty using that arm and are physically weak on a weekend.. you will decide to wait until Monday to trot down to the doctors office.. rather than go to the ER....:roll:

I suggest you don't.


Seriously man.. you are just digging your hole deeper. But whatever.

And if you show up, the ER doc will just wave you thru and admit you, because, gosh...its pain.

I didnt say it wasnt worth an evaluation. I said its not necessarily an admission. Yeesh.