As a Transitions Care Manager/Discharge Planner, the following challenging case scenario arises:The
As a Transitions Care Manager/Discharge Planner, the following challenging case scenario arises:The physician is ready to discharge the patient based on her assessment of a healing incision and stable vital signs, able to ambulate with assistanceThe insurance company is authorizing no further hospital days and is denying the referral request made by you under MD direction for Skilled Nursing Rehabilitation because the patient walked 4 feet further than their guidelines for rehab indicate. You provided this status information to the insurance reviewer in an earlier email to themThe hospital administrator is directing you to discharge the patient home with PT, or “whatever is needed”; he is under pressure to get hospital length of stay reducedThe family is stating that you are only acting in the hospital’s interest and discharging early to save moneyYour assessment is that the patient is not yet ready for discharge based on other issues she has that the MD is not addressing, and that the correct discharge level of care is SNF Rehabilitation. Additionally the patient has early dementia, her spouse has apparent cognitive impairment and the only adult child is out of state, and is working with you by telephone. The spouse and patient still have decision authority although you are concerned about their capacity and their decisions.Questions:Based on the scenario above, what ethical and legal considerations arise in the situation and how might the Transition Care Manager approach them? What are the conflicting/competing incentives? Who is liable if a decision to discharge is unsafe or results in harm to the patient? Health Science Science Nursing NURS 3202 Share QuestionEmailCopy link Comments (0)
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