Bounceback prevention

STEP 1

Identify High Risk patients:

-High risk complaint without definitive diagnosis on d/c (eg A/P, C/P, H/A, F)

-Abnl VS

-Condition making it less likely pt will return for worsening symptoms (mental/psych/substance abuse)

-Chronic dz with decompensation

-Difficulty obtaining accurate data (language, dementia, inebriation, etc)

-Advanced age

-Upset pt

-Unmet pt expectations

-Bouncebacks (a pt return, us within 72h)

-OVERALL: a pt you will worry about after your shift

STEP 2

Review your evaluation prior to d/c:

-Address ALL documented complaints in H&P

-Confirm hx is accurate

-Consider potentially serious dx

-Explore abnl findings

-Write a progress note explaining medical decision-making process (if unclear in H&P)

-Assure that aftercare instructions are specific and f/u is timely and available

-Confirm that pt understands and is comfortable with the plan

-OVERALL: Complete a medically and legally defensible eval which is reflected in the documentation on the chart

Source

"Bouncebacks" (Weinstock, Longstreth)