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Ugh. I am soooo glad I only have one more weekend left doing hospice triage. The suckitude has really gotten old.
Had a major bruhaha this weekend over a pediatric patient at local hospital who needs hospice care.
Peds Doc (hereafter Dr S) calls me to ask if hospice can supply oxygen at home. I tell him yes, but ask who the patient is. Turns out, the patient has not been admitted to our services yet, though Dr S insists our pedi hospice doc has "accepted" this patient.
Well, that's all fine and dandy, though I think it's a bullshit statement (our hospice docs don't accept patients, they merely co-manage the patients who are admitted by their own docs)
However, it doesn't matter. Until the patient is formally referred to us for services, we can't do the admit. There are issues of insurance eligibility that have to be gone over, plus the patient must be assessed by an RN to determine if the potential patient meets admission criteria. Those things hadn't been done. Until they are done, I can't arrange for equipment to be delivered to the home.
Dr S didn't like this. She kept insisting our doc had "accepted the patient."
Me: I'm sorry. I don't know anything about it. Without a referral, I have no where to start. However, I can take referral information from you and have them contact the family on Monday.
Dr S gets upset and hangs up.
Fast forward to today. I get a call through the answering service to call a case manager "as soon as possible." No patient name or issue provided. A few minutes later, the answering service calls back to give the patient name. I look it up in my computer; not there. Not our patient.
So, I call her back.
Me: Can you confirm the patient name, please? I'm not finding him in our system.
Case Manager (CM): *confirms name*. Our doctor says your doctor has accepted him for admission to your pediatric hospice. She wants to discharge him today and send him home with oxygen.
Me: Ah, yes, I remember. I told her yesterday we don't have a referral on this patient. We don't usually do weekend admissions unless they are planned in advance, anyway, so I doubt we can admit this patient today. I need to get referral information to the Referral Center and they can take this up Monday.
CM: But Dr. S says your doctor agreed to accept him.
Me: That hasn't been communicated to me. I have no information on this patient. That makes it very difficult for us to do an 11th hour admission. Is this patient going to die in the next 24 hours?
CM: Oh, no. He just has constant seizures and every time he has one, his parents bring him to the hospital.
Me: *thinking, aha! the plot thickens* I see. Do we even know if the parents accept hospice? *I'm thinking not, if that's how the parents are handling this*
CM: Uhm. I don't know. I understand, but she really wants to discharge this patient today. Is there anything I can do to make this happen?
Me: Well, for starters, I need a copy of the chart faxed to *fax number*: H&P, demographics, and medications, along with an order for hospice and the oxygen. Your doc is going to have to admit him to our services.
CM: OK.
Me: I'm not promising anything today. I'll call our peds nurse and find out what she wants me to do about this. But I have to tell you, I am feeling very pinched by this. Your doctor has put the cart before the horse and laid this all on me. I doubt we can do a weekend admission if the patient is not expected to die within 24 hours, and frankly I don't hear anything that makes that really necessary. But I'll see what our peds nurse wants me to do.
So I call the peds nurse and guess what?
She already knew about this patient. Dr. S had asked our doctor if he thought this patient would meet hospice criteria. Our doc had said yes. That's a far cry from "accepting" this patient for admission. And Dr. S had been told that a weekend admission this weekend would not happen, but she had not listened.
So I call CM and tell her it's a no go for today. The Referral Center will deal with it Monday.
I really don't like it when doctors promise things to patients they can't deliver, then make hospice out to be the bad guys.
This whole thing was hospital driven; they wanted to get the patient out of the hospital and they only way they could do so was to go through hospice. I'm betting the parents don't have insurance which is why they didn't just get the home health agency involved.
Had a major bruhaha this weekend over a pediatric patient at local hospital who needs hospice care.
Peds Doc (hereafter Dr S) calls me to ask if hospice can supply oxygen at home. I tell him yes, but ask who the patient is. Turns out, the patient has not been admitted to our services yet, though Dr S insists our pedi hospice doc has "accepted" this patient.
Well, that's all fine and dandy, though I think it's a bullshit statement (our hospice docs don't accept patients, they merely co-manage the patients who are admitted by their own docs)
However, it doesn't matter. Until the patient is formally referred to us for services, we can't do the admit. There are issues of insurance eligibility that have to be gone over, plus the patient must be assessed by an RN to determine if the potential patient meets admission criteria. Those things hadn't been done. Until they are done, I can't arrange for equipment to be delivered to the home.
Dr S didn't like this. She kept insisting our doc had "accepted the patient."
Me: I'm sorry. I don't know anything about it. Without a referral, I have no where to start. However, I can take referral information from you and have them contact the family on Monday.
Dr S gets upset and hangs up.
Fast forward to today. I get a call through the answering service to call a case manager "as soon as possible." No patient name or issue provided. A few minutes later, the answering service calls back to give the patient name. I look it up in my computer; not there. Not our patient.
So, I call her back.
Me: Can you confirm the patient name, please? I'm not finding him in our system.
Case Manager (CM): *confirms name*. Our doctor says your doctor has accepted him for admission to your pediatric hospice. She wants to discharge him today and send him home with oxygen.
Me: Ah, yes, I remember. I told her yesterday we don't have a referral on this patient. We don't usually do weekend admissions unless they are planned in advance, anyway, so I doubt we can admit this patient today. I need to get referral information to the Referral Center and they can take this up Monday.
CM: But Dr. S says your doctor agreed to accept him.
Me: That hasn't been communicated to me. I have no information on this patient. That makes it very difficult for us to do an 11th hour admission. Is this patient going to die in the next 24 hours?
CM: Oh, no. He just has constant seizures and every time he has one, his parents bring him to the hospital.
Me: *thinking, aha! the plot thickens* I see. Do we even know if the parents accept hospice? *I'm thinking not, if that's how the parents are handling this*
CM: Uhm. I don't know. I understand, but she really wants to discharge this patient today. Is there anything I can do to make this happen?
Me: Well, for starters, I need a copy of the chart faxed to *fax number*: H&P, demographics, and medications, along with an order for hospice and the oxygen. Your doc is going to have to admit him to our services.
CM: OK.
Me: I'm not promising anything today. I'll call our peds nurse and find out what she wants me to do about this. But I have to tell you, I am feeling very pinched by this. Your doctor has put the cart before the horse and laid this all on me. I doubt we can do a weekend admission if the patient is not expected to die within 24 hours, and frankly I don't hear anything that makes that really necessary. But I'll see what our peds nurse wants me to do.
So I call the peds nurse and guess what?
She already knew about this patient. Dr. S had asked our doctor if he thought this patient would meet hospice criteria. Our doc had said yes. That's a far cry from "accepting" this patient for admission. And Dr. S had been told that a weekend admission this weekend would not happen, but she had not listened.
So I call CM and tell her it's a no go for today. The Referral Center will deal with it Monday.
I really don't like it when doctors promise things to patients they can't deliver, then make hospice out to be the bad guys.
This whole thing was hospital driven; they wanted to get the patient out of the hospital and they only way they could do so was to go through hospice. I'm betting the parents don't have insurance which is why they didn't just get the home health agency involved.
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