- Joined
- Jul 7, 2020
- Messages
- 121
- Reaction score
- 74
Since starting at the “House of God” I’ve seen some things.
I don’t know the whole backstory here, but we had an objectively unsafe discharge here from Neuro ICU. An incapacitated aphasic neuro patient was discharged 26 hrs after acute onset of cortical signs (basically MCA syndrome). 1123F documentation of surrogate decision maker. Again, no idea of the whole story (just records and snippets of talk) but the word coming down the pipeline is that all providers on the case have to “come together” since admin is sensitive to the latest report of pt dumping from Valley Hospital in NV. I was really getting the vibe of “let’s get our story straight” around the proverbial water cooler yesterday.
Word is that there’s going to be an internal review for SOC reporting and due to my background admin asked me informally to provide a written review in advance. I was supplied with four different edits of the “record” and spent the night reading through. So, even without the alterations and obliterations, it’s bad, folks.
Uh…so…now the last edit of the record shows that discharge provider, OT, SLP, and the day RN massaged a “pt left AMA” notation in the pt record. I talked to social work today, he let slip that he saw the pt and the pt was not ready for discharge and could not express anything. Overheard third hand PT said the pt was effed up, high fall risk, couldn’t talk, was apparently trying to be cooperative but couldn’t consistently follow commands, etc. I wheedled out of security a verbal that the pt did ambulate out of the room with the assistance of whoever was rooming in and the day nurse. I viewed footage over lunch and there were a number of anterior losses of balance and the pt had no shoes on his feet. Pt went by security checkpoint to get out of hospital basically using his wife? or gf? as an assistive device, teetering, and no shoes. Why didn’t security question it? Discharge orders. I’m so exhausted that the ridiculousness of this is causing inappropriate laughter.
What could be worse here? Stroke protocol was not completed. Discharge provider noted pt refusal to have an MRI even with surrogate-signed screening form and written consent on file. No AMA documents (signed or otherwise) or AMA education noted. No note of surrogate decision maker involvement in discharge or discharge planning. Discharge summary not provided to surrogate decision maker or pt, noted withheld by discharge provider. Oral meds with no instructions for safe administration ordered for strict NPO pt on discharge and scripts sent to pt pharmacy of record. This is a total WTF case.
Basically, if the pt family doesn’t sue over the likely and foreseeable residual deficits (or pt death?) I’ll be surprised. I’m guessing my report is going to end up with legal to consult on potential settlement size as well as scale how wide the internal SOC review has to go. Seriously…what the heck?
Updating CV…prepping to get away from this cluster. Just writing somewhere to commiserate and keep sane. I agreed to review with good intentions…giving the benefit of the doubt…but no way I’m closing ranks on this mess.
I don’t know the whole backstory here, but we had an objectively unsafe discharge here from Neuro ICU. An incapacitated aphasic neuro patient was discharged 26 hrs after acute onset of cortical signs (basically MCA syndrome). 1123F documentation of surrogate decision maker. Again, no idea of the whole story (just records and snippets of talk) but the word coming down the pipeline is that all providers on the case have to “come together” since admin is sensitive to the latest report of pt dumping from Valley Hospital in NV. I was really getting the vibe of “let’s get our story straight” around the proverbial water cooler yesterday.
Word is that there’s going to be an internal review for SOC reporting and due to my background admin asked me informally to provide a written review in advance. I was supplied with four different edits of the “record” and spent the night reading through. So, even without the alterations and obliterations, it’s bad, folks.
Uh…so…now the last edit of the record shows that discharge provider, OT, SLP, and the day RN massaged a “pt left AMA” notation in the pt record. I talked to social work today, he let slip that he saw the pt and the pt was not ready for discharge and could not express anything. Overheard third hand PT said the pt was effed up, high fall risk, couldn’t talk, was apparently trying to be cooperative but couldn’t consistently follow commands, etc. I wheedled out of security a verbal that the pt did ambulate out of the room with the assistance of whoever was rooming in and the day nurse. I viewed footage over lunch and there were a number of anterior losses of balance and the pt had no shoes on his feet. Pt went by security checkpoint to get out of hospital basically using his wife? or gf? as an assistive device, teetering, and no shoes. Why didn’t security question it? Discharge orders. I’m so exhausted that the ridiculousness of this is causing inappropriate laughter.
What could be worse here? Stroke protocol was not completed. Discharge provider noted pt refusal to have an MRI even with surrogate-signed screening form and written consent on file. No AMA documents (signed or otherwise) or AMA education noted. No note of surrogate decision maker involvement in discharge or discharge planning. Discharge summary not provided to surrogate decision maker or pt, noted withheld by discharge provider. Oral meds with no instructions for safe administration ordered for strict NPO pt on discharge and scripts sent to pt pharmacy of record. This is a total WTF case.
Basically, if the pt family doesn’t sue over the likely and foreseeable residual deficits (or pt death?) I’ll be surprised. I’m guessing my report is going to end up with legal to consult on potential settlement size as well as scale how wide the internal SOC review has to go. Seriously…what the heck?
Updating CV…prepping to get away from this cluster. Just writing somewhere to commiserate and keep sane. I agreed to review with good intentions…giving the benefit of the doubt…but no way I’m closing ranks on this mess.