Hospitalizations and Pdn

Specialties Private Duty

Published

When you pts have an emergency and need to go to the hospital,does your agency make you go with the parents and child? Most agencies tell us to go,but follow the ambulance in our own car. Some say don't go anywhere;you have to go home because its the caregiver responsiblility.

Agency M tells us to stay until the kid gets admitted or discharged,because leaving would constitute "abandonment". The kids aren't the hospital's responsibility until either admission or discharge.

Another agency says as soon as the kids are in the hospital or ambulance,its the hospital's responsibility and the parents responsibility. You must leave as there is no reimbursement by the insurance companies.

What are your agencies rules?

I'm curious, because I have stayed in the hospital with some of the kids until admission or d/c and none of the nurses who worked for the hospital didn't do any actual hands on care, but they did take vitals.

I had to do all the suctioning of the trachs and changing the diapers.

Almost all of the parents have said when they wait in the ER(about 4 hrs around here) if the Pdn wasn't there that they would have to do everything themselves.

Specializes in Pediatrics, Emergency, Trauma.
My experiences track with yours ventmommy and eeffoc. The plan of care specifically permits accompanying the client on outings (including visits to their doctor) and prohibits the nurse from transporting in their own vehicle. It helps to have an extra set of ears at these appointments and expedites processing of new orders. For the sake of parents or pcgs I'm glad this works out. The transport and admission process is stressful for everyone.[/quote']

THIS. :yes: I have never been not paid for taking a child to a Doctor's appointment; especially in the POC and policy it is permitted; I have never worked with an agency that did not pay me for going to a doctor's appointment, whether it would be reimbursable-or not.

Specializes in Pediatric Private Duty; Camp Nursing.

I have been to a dr's appt w a client once, I just documented it within my nurse's notes, and I submitted it to the agency and I got paid. I never thought twice about it until this thread. In the past, my agency has paid me for extra driving time up to an hour out of my way to get around major accidents. I tried to get to the job in good faith on time, they realized I shouldn't lose an hour of work burning gas stuck in traffic, but they couldn't bill insurance for that time, either. When I got paid, the itemized list of services had that extra hour down as "ALL". I'm assuming the agency has some sort of slush fund that they pay for extra hours out of their own profits.

Specializes in Pediatrics, Emergency, Trauma.
I have been to a dr's appt w a client once I just documented it within my nurse's notes, and I submitted it to the agency and I got paid. I never thought twice about it until this thread. In the past, my agency has paid me for extra driving time up to an hour out of my way to get around major accidents. I tried to get to the job in good faith on time, they realized I shouldn't lose an hour of work burning gas stuck in traffic, but they couldn't bill insurance for that time, either. When I got paid, the itemized list of services had that extra hour down as "ALL". I'm assuming the agency has some sort of slush fund that they pay for extra hours out of their own profits.[/quote']

Oh, they do; nursing care by CMS is FAR more that what we get paid for...some agencies take up to 40% of the reimbursable rate of nursing care.

Whether or not I go, and how long I stay with the patient, usually depends upon what I am told by the agency when I call to let them know what is going on. Sometimes I go with the patient (with family member in their car), or if near shift change, I only stay until they are loaded into the ambulance. This decision is made at the time of the phone call to the agency. And, I've always been paid, when I go to the hospital, otherwise, I wouldn't do it!

Specializes in Peds(PICU, NICU float), PDN, ICU.

Sigh. . .I guess we have to get used to this. I can see the hospital or emergency dept being classified as "another provider" since they do have resources in place, but the average employee at a doctor's office (who may be a MA) is not going to have a clue what to "provide" if anything goes wrong, which alarm means what, etc., especially with fragile vent patients.

Most nurses I know will probably take the pay hit as leaving and returning is often not feasible with driving distances factored in.

I've used that same argument. MAs can't touch a trach/vent. But the Dr can. What Dr is going to suction the pt while s/hes waiting to be seen? I've also seen where parents let nurses go early based on how long the nurse is at the Dr office. But that's a whole other thread. There was talk of medicare/medicaid changing the rules about it.

I know in Nj,most kids get transported to Doctor's appointments using an ambulance.

I haven't seen any kids where Mom drives them to appointments.

There are ususally 3 EMT's,and a critical care RN on board.

Another nurse told me Nj is trying to crack down on "double billing".

I never had an issue with going to Dr appointments.

So for one vent/trach kid,they have 2 nurses,3 Emt's,plus Mom.

Its totally overkill.

Now,there is a great rationlae for it howvever.

The Critical care Rn explained that it doesn't make sense for Nj to try stop the double billing.

According to her,I don't have the proper equipment if his heart stops(I don't have any epi nor Atropine.

She said that makes us Pdn's not equiped,even though we(the Pdn) have the Emergency back up vents,batteries,and supplies with us.

Just to add,I wonder why she thinks compressions aren't enough if his heart stops?

Specializes in nurseline,med surg, PD.

Mypatients have not used an ambulance. However we have made numerous trips to doctor appts and ER visits. I always stay until the patient is admitted.I get paid for that.Generally I am quite busy since the patient wouldnt be there if they werent sick.

Specializes in Current: ER Past: Cardiac Tele.
Just to addI wonder why she thinks compressions aren't enough if his heart stops?[/quote']

There are other arrhythmias than just the heart stopping. The critical RN was probably referring to having a defibrillator and ACLS drugs on hand for those other arrhythmias.

I have always been paid when going with the patient to doctors office. If my patient needs to go to the ER - I notify my agency, the agency has had me go with them and a few times they just went ahead and sent me home for the day since it was so close to the end of my shift. Either way I was paid for my time with the patient.

I would be looking for another job if I were to be told I was not going to be paid for the time spent with the patient in the doctors office - there have been times when my patient has had 2-3 apppointments back to back and we have been at the facility for 5-7 hours.

Specializes in Complex pedi to LTC/SA & now a manager.

Almost none of my patients in PDN go by ambulance. Only one goes by ambulance that is trach-vent because parent isn't available to transport. Policy is trach vent needs ALS if going by non-parent transport so a team of 3 (basic EMT, CCRN, and medic as CCRN & medic have different scope/ protocol) EMT basic drives. Otherwise, If ACLS/ALS is needed during a shift or transport, just like a stable cardiac or asthmatic or anaphylactic child, 911 is called. Whether PDN goes to ER is depending if parent home and if near end of shift. Sometimes the only way family will agree to an ER transfer is if a trusted PDN comes along/follows. I've been in that position and was appropriately paid for my time.

Care is generally NOT transferred to physician office so PDN is billable and we are paid. We just document a single line that "routine outpatient visit with (specialty) new/no new nursing orders received. ". Many of my patients go to one of the major pediatric hospitals 2 in-state, several out of state, and so parents "stack visits" beginning with an 8 am appointment. We leave at 6am and don't return home until 5/6 PM. This way parent only misses one day of work. It helps when we have to call for orders that these physicians are familiar with us and trust our assessment & observation and are willing to give phone orders rather than drag in for an outpatient appointment.

If a child goes in for same day surgery or a procedure (not testing like an x-ray or U/S but more like Botox under sedation) then PDN does not go unless parent/caregiver is not available especially if anesthesia or sedation is required as the critical care nurses & physician assume care for the child. I've seen nurses go on these appointments and the claim get flagged upon review when the nurse starts documenting assessments & care done by the hospital team. The clinical manager decides if PDN needs to go (usually no if parent is available and PDN meets at home post discharge) and then pay either by insurance billing or discretionary funds.

Radiology, lab, and similar procedures don't generate procedural physician or nursing charges. Outpatient sedation does and thus the PDN claim is denied

Specializes in Pediatrics, Emergency, Trauma.

Thanks JustBeachy for the clarification; your explanation is what I have experienced and my understanding of the process. :yes:

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