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“Admission Denial”

Use in Emergency

Not really words that as an E.D. doc we used to have to think about.   Of course, these words are taking on a whole new meaning for us when we try to readmit that CHF’er who decided they really needed a smoke to go home to “take care of business,”  and we then get push-back from the admitting service or Utilization Review nurse.

It’s not our fault the patient decided that they didn’t like the food. Or that they felt they would get more frequent narcotic administration by absconding from the hospital ward and coming down to the E.D.   I get that patients become bored on the floor and feel like no one is paying attention to them when rounds are just once a day.  I understand that patients sometimes feel like “the doctor wasn’t doing anything anyways just sending me off for a bunch of tests.”  I’m sorry if they left last time;  however, their lung cancer, GI bleed, cardiac disease, end-stage renal disease is a reality, and they really do need to be in the hospital.

Somehow, though, I don’t quite get the patient who was stabbed in the shoulder, had a tension pneumothorax we needle decompressed and who we then admitted with a chest tube, who didn’t want to “wait around the hospital” and so absconded with their chest tube in place and carrying their Pleuravac. To their credit, they did show up back in the E.D. two days later saying that’s when he was originally told he was going to have his chest tube removed and was back to have it taken out.

I also had another patient who developed chest pain and walked to their closest fire department where they proceeded to collapse on the steps. The firemen performed CPR and defibrillated the patient getting back a pulse when EMS arrived. The STEMI was evident on the pre-arrival EKG, and we got the patient to the cath lab within 30 minutes. He, of course, absconded just after his angioplasty because, “he’d been on his way to do something, and couldn’t be sitting around the hospital doing nothing.” He shows up from time to time with anginal pains. Probably because a proper discharge would have included medications which he didn’t get that would have helped with those pesky clogged arteries.

Don’t even get me started on why he hasn’t filled his scripts yet….

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