CASE STUDIES:

Overturning Denials

Difficult inpatient-stay denials

operation, operating room, doctor

CLINICAL SUMMARY

59 y/o female presented with ‘tightness’ and left-sided chest pain that began at rest. Patient reports similar pain several times over the last month. Patient suddenly awoke with severe left lower quadrant pain which is a chronic issue for her IBS/colitis. Shortly after her abdominal pain started, she reports left-sided chest discomfort with associated nausea. Patient reports a large amount of stress at home.

CLINICAL SUMMARY

A 47-year-old patient was admitted for an intentional drug overdose, suicidal ideation, anxiety depression and alcohol abuse. Past medical history showed the patient suffered from bipolar disorder, anxiety depression panic attacks. The ER report stated the patient arrived via EMS after taking one bottle of benzodiazepines along with alcohol but was alert. The patient was admitted to a step-down unit with 1-on-1 sitter for suicidal and seizure precautions.

CLINICAL SUMMARY

A 36-year-old new mother with a recent C-section was admitted after an ER visit due to shortness of breath occurring since the delivery of her child and drainage from her surgical incision. The patient had a significant past medical history of morbid obesity, asthma, and sleep apnea. The physician summary showed the patient had acute toxic respiratory failure due to asthma exacerbation.

CLINICAL SUMMARY

A 69-year-old female with past medical history of atrial fibrillation, aortic/mitral valve replacement, chronic anticoagulation, hypertension, hyperlipidemia, diabetes mellitus, neuropathy, GERD, COPD. The patient was admitted to the hospital with chief complaint of abdominal pain and bright red blood per rectum. The CT of the abdomen pelvis showed diffuse colonic bowel wall thickening compatible with colitis/diverticulitis.

CLINICAL SUMMARY

A 79-year-old patient was scheduled to have an elective cardiac ablation which went well, but the patient developed hypotension post procedure. In a previous ablation procedure, the patient had a similar response post ablation with hypotension requiring several days of hospitalization. The most recent hypotension required Levophed. The patient was also diagnosed with a UTI prior to the ablation and antibiotics were on-going.

CLINICAL SUMMARY

Patient was admitted to the hospital for orbital cellulitis IV treatment. The patient presented with left eye redness and pain with movement, especially over the left gaze. There was no history of recent trauma. Maxillofacial CT showed mild left globe proptosis with preseptal edema, mild rectus enlargement with possible surrounding fatty stranding. As per ophthalmology patient was thought to have possible orbital cellulitis and placed on broad-spectrum IV antibiotic therapy. The patient, who also had a history of drug abuse, decided to leave against medical advice while being treated.

CLINICAL SUMMARY

An 80-year-old patient with a past medical history of atrial fibrillation, arthritis, congestive heart failure, COPD, hyperlipidemia, hypertension, history of PE, pacemaker GERD, arrived in the Emergency Department with chest pain which had been occurring for a week.

CLINICAL SUMMARY

A 48-year-old male patient was admitted for fluid overload with symptoms of shortness of breath and weakness due to missing hemodialysis appointments. The patient had a significant past medical history of hypertension, dyslipidemia, atrial fibrillation, end-stage renal disease and was on hemodialysis three times a week. When admitted, the patient was also complaining of a recurrent abscess in the mouth previously drained but not treated due to a missed follow-up. The patient was admitted for incision and drainage of the abscess and IV antibiotics.

CLINICAL SUMMARY

Patient with SCC oropharyngeal cancer was admitted to the hospital with alcohol withdrawal. No beds were available at a detox center; therefore, the patient was brought to the Emergency Department for help.

CLINICAL SUMMARY

Patient with a history of asthma and a high BMI was admitted with asthma exacerbation and a wound infection.

CLINICAL SUMMARY

A 66 year-old patient undergoing total hip arthroplasty. The patient received an ASA score of 3, having multiple comorbidities including asthma and need for postoperative supplemental oxygen therapy.

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Can Peer-to-Peer reviews overturn short hospital stay in-patient denials? We have done a limited study and seen the benefit of P2P reviews at AppriseMD and how it can reverse denials and recoup dollars for hospitals.

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