Month: February 2022

Case Study: Sepsis presents challenging denial

CLINICAL SUMMARY This case involved a 74-year-old patient who presented with chills and a temperature of 103°F. The patient had a past history of hypertension, arthritis, and right total shoulder replacement in January 2021. Chest x-ray showed coarse perihilar and interstitial markings, likely viral or reactive. A CTA chest was negative for pulmonary embolism or …

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Case Study: Diabetes patient short stay

CLINICAL SUMMARY This case study involves a 54-year-old female patient with a past medical history of type I diabetes, diabetic gastroparesis, nephrolithiasis, hypothyroidism, hypertension, and traumatic brain injury. She arrived in the ER out of concern for diabetic ketoacidosis (DKA). The patient was hospitalized for DKA one month before this admission. She had been sick with …

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Case Study: Bilateral Pneumonia

CLINICAL SUMMARY: Bilateral Pneumonia A 23-year-old nonverbal female patient arrived in the emergency department with her parents who said she had a fever and heavy breathing since the morning. The patient’s medical history included Lennox-Gastaut Syndrome, severe mental retardation, seizure disorder, recurrent aspirations, recurrent pneumonia and vagal nerve stimulator. Her parents said she had been …

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How does the two-midnight rule apply when a traditional Medicare patient has no safe discharge plan?

For a traditional Medicare patient admitted for observation, it is not uncommon to remain in the hospital longer than two midnights due to non-medical reasons including waiting for a transfer to another facility or family situations. In these cases, the reason the patient remains hospitalized is the lack of a safe discharge plan. Should such …

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Case Study: Chest pain, non-cardiac can be difficult to get admission status correct

Chest pain is one of the most common ER diagnoses. For those patients who require hospital admission, getting the admission status correct and paid by the insurance company can be tricky. One such case involved a patient who arrived in the ER with chest pain presumed due to unstable angina (TIMI 3). The patient was …

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