Case Study Help Please! Problem Solving Situation

[kwagner_51]

Here is the situation:

CASE: #1: PROBLEM SOLVING SITUATION (MarqUis and Huston, 1992)

You are the evening house supervisor of a small, private, rural hospital. In your role as house supervisor, you are responsible for staffing of the upcoming shift, and for troubleshooting all problems that cannot be handled at the unit level.

Because of legislative changes and reduction in federal monies being reimbursed to your facility over the last few years, the hospital has developed a policy that says that indigent admissions (patients who cannot pay for their services) shall not exceed 30% of the total patient census. Thus, the emergency room is expected to carefully screen all patients and refer non-critical indigent patients requiring hospitalization to county facilities that are approximately 30 minutes away.

Tonight, you receive a call to come to the emergency room to handle a "patient complaint." When you arrive, you find a Hispanic woman in her mid-20s arguing vehemently with the emergency room charge nurse and physician. When you intercede, the patient introduces herself as Teresa Garcia and states "There is something wrong with my father and they won't help him SInce he can't pay. If we had money, you would be willing to do something." The charge nurse intercedes by saying, "Teresa's father began vomiting about two hours ago and blacked out 45 minutes agofollowing a 14 hour drinking binge." The ER physician added, "Mr. Garcia's blood alcohol level is 0.25 (two and One-halftimes the level required to be declared legally intoxicated) and my physical exam would indicate nothing other than he is drunk and needs to sleep it off. Besides, I have seen Mr. Garcia in the ER before and it is always the same thing."

Teresa persists in her pleas to you that "there is something different this time" and she feels the hospital should evaluate her father further. She intuitively feels that something terrible will happen to her father if he is not cared for immediately. The ER physician becomes even more angry after this comment and states to you, "I am not going to waste my time and energy on someone who is just drunk and I refuse to order any more expensive lab or x-ray examinations on this patient. If you want something else done, you will have to find someone else to order it." With that, he leaves the room and returns to the examination room where other patients are waiting to be seen. The ER nurse turns to look at you and is waiting for further directions.

I am a 2nd year nursing student in the ADN program. I have no idea what authority a house supervisor has.

Thanks All help/suggestions are greatly appreciated

________________________________________

In His Grace,

Karen

Failure is NOT an option!!

[VivaLasViejas, ASN, RN]

As the house supervisor, you really can't overrule a physician, but you can go up the administrative food chain, to the nursing director and even the administrator if need be, if YOU think the pt. needs additional medical evaluation. The question to ask here is, does the hospital in question receive federal funding? There are law that prohibit patient "dumping" at any hospital which receives Medicare or Medicaid funding; it includes the obligation to treat and stabilize patients without regard to their ability to pay. Such a hospital cannot make policies that turf patients to other facilities in this manner, so the 30% rule can't be enforced (by the ER doc or anyone else).

That said, in the real world, uninsured patients often DO get the 'treat-and-street' type of care, and in all likelihood this patient would be sent home after a perfunctory exam by the ER physician no matter how much the man's daughter protested. If you took it a step or two further, the patient COULD have something seriously wrong that goes undiagnosed and leads to permanent disability or death, which would undoubtedly result in a huge lawsuit and bad publicity for the hospital........but if you've advocated for the patient and family and been overruled, you can't really be held responsible.

I don't know if that answers your question. Good luck with your studies.

[USA987, MSN, RN, NP]

ER must treat the patient until deemed stable or transfer to another facility is arranged...to do otherwise would be violation of the EMTALA laws...