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The Diagnosis – Admit or not to Admit?

Posted Apr 16 2009 11:53pm

This is a post made by the Happy Hospitalist talking about an error, not deadly, but one that maybe should not have required admission to the hospital based on an error in the draw.  One nice thing he does is to make sure to follow up and get the record corrected for insurance purposes, which is nice as something like this could give the individual trouble down the road.  We are humans and make errors, but it’s always good to double check as it can hit any of us at any time.  This was a good post in the fact that he asked for input from many to see what their thoughts were. 

Also, what about his time?  Good question and something we all ponder with healthcare.  Right now with all the discussions on how to reduce admissions and re-admissions, this is very timely.  Visit the post to read all the details.  BD 

CC: lightheadedness
A healthy 32 year old male lawyer with no chronic medical conditions presents to an urgent care center with acute onset of lightheadedness associated with transient nausea and vomiting. No other complaints. No nothing. No home meds. No illnesses. No surgeries. Review of systems otherwise negative. Physical exam negative.
Laboratories come back. He is transferred for direct admission.
Na 142
K 2.8
HCO3 20
CL 120
BUN 14
Cr 0.9
Ca 5.1
Alb 2.6
TP 5.1
LFTs otherwise normal
WBC normal, normal diff
Hgb 8.7
MCV 90
Plt 97K
UA negative
cardiac panel and CXR are negative
Impression: 1) What the hell is going on?
Plan: Differential diagnosis anyone?

The correct answer award goes to Nurse K for this iatrogenic nursing diagnosis.
Repeat labs at Happy's hospital the following morning were all normal. After discussing the case with the urgent care center, we came to the conclusion that the nurse had drawn the blood during the nurse draw placement of an IV (assumed to be diluted from placement technique, I think).
My first inclination was that somehow the first set of data was reported on the wrong patient. But a third set confirmed the accuracy of the normal second set.
This was an iatrogenic admission for an outpatient diagnosis of lightheadedness from being overworked which resulted in IV calcium and IV potassium and a night in the hospital. This is a hospital error. This is a never event. Not delerium. Not c difficile. Not hospital acquired VTE.

It's interesting. I found myself wondering about the insurance implications for the patient should he try to insure in the future. I made sure his record was cleaned up. I dictated a later to be sent to his home address indicating the hospital error. I made sure it was well documented in his discharge summary. And I called the billing office to inform them that his insurance should not be billed for his hospital stay.
Now the question is, should I be able to collect for the work I did during a hospital stay that was not medically necessary?

A Happy Hospitalist: Admitting Diagnosis: I Don't Know

Technorati Tags: hospital, healthcare, admissions
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