Most annoying reason for admission?

JustKeepSmiling, ADN, BSN, RN · Mar 1, 2015

I work at a rural hospital and a larger city one - huge difference in admits. And the inapproriateness of the unit admitted to!!

Things that drive me...

Admit dx UTI but u/a is clean, not even bacteria??

AMS on an 89y/o nursing home patient, they get to the floor and are magically oriented now?

Constipation in an AAOx3 middle aged person who has tried NOTHING at home then proceeds to FREAK out over the enema.

90's something y/o s/p fall at home, completely oriented, no evidence of fx on xrays, head CT neg, pt denies hitting head or change in LOC, actually pt DENIED pain and was STILL admitted. Why??

Dehydration with a BUN of 15 and Cr of 0.80. Seriously, my BUN/Cr is probably worse than that on a 12 hr shift.

Severe Anemia. HH 10/30 and no orders to transfuse.

I could go on...

Then the pts that get admitted to medsurg who roll up with 70's/30's and get an immediate rapid response and get rolled straight to ICU.

Glycerine82, LPN · Mar 1, 2015

had a pt with conversion syndrome. It was the strangest thing, because he presented with CVA symptoms. What was so strange to me was that sometimes he could use his arm and sometimes he couldn't.

I don't know if thats part of it or not, but it seemed so strange to me that sometimes he'd be fine and the next minute he wasn't.

Really made me feel like he was making it all up, although I never let on that was what I thought, there was just something about him....

KatieMI, BSN, MSN, RN · Mar 1, 2015

I work at a rural hospital and a larger city one - huge difference in admits. And the inapproriateness of the unit admitted to!!
Things that drive me...
Admit dx UTI but u/a is clean, not even bacteria??
AMS on an 89y/o nursing home patient, they get to the floor and are magically oriented now?
Constipation in an AAOx3 middle aged person who has tried NOTHING at home then proceeds to FREAK out over the enema.
90's something y/o s/p fall at home, completely oriented, no evidence of fx on xrays, head CT neg, pt denies hitting head or change in LOC, actually pt DENIED pain and was STILL admitted. Why??
Dehydration with a BUN of 15 and Cr of 0.80. Seriously, my BUN/Cr is probably worse than that on a 12 hr shift.
Severe Anemia. HH 10/30 and no orders to transfuse.
I could go on...
Then the pts that get admitted to medsurg who roll up with 70's/30's and get an immediate rapid response and get rolled straight to ICU.

Because nowadays every single provider has to think first and foremost about covering his or her back, butt and other parts of the body and only after that about everything else.

I cannot find this article right away but somewhere around 2005 there was 1 (one) case report about elderly patient who fell somewhere out of hospital; there were no symptoms, all tests run negative and the guy was sent to whence he came from. Unfortunately, as he was on aspirin or something like it, he developed slow epidural bleed and ended up in vegetative state for quite a while before passing out. The case report was mostly about atypical development of the bleed and the author suggested serial CT scans for patients from this "special" population (which, in fact, encompasses almost every person over age of 65 who ever saw a "traditional" health care provider of any level or specialty in this country). In fact, it was the most ordinary "anecdotal report" about unusual and interesting clinical case, the sort of those published by dozens by great and small medical journals every month. This particular case became notoriously well-known because the family sued, found experts who testified that "outcome might be different" if the patient would had been admitted as inpatient and the said serial scans were not most negligently omitted, and won a load of money. After that, hospitals jumped en masse to change existing policies so that immediate non-contrast CT of the head would be performed in case of any fall, near fall, or any other situation which might potentially lead to any sort of head trauma if patient is at or above the certain age and/or takes something from very long list of meds, i.e. Tylenol (yes, acetaminophen doesn't cause any sort of coagulopathy by itself, but it can cause liver injury and it can in turn cause coagulopathy - d***the fact that patient should be quite near need of liver transplant if he ate that much Tylenol). Soon after that, there was a wave of publicity, as well as corresponding suing activity, regarding cranial traumas among athletes. Some bad outcomes were, again, blamed on inadequate assessment and diagnostic testing, so now everyone regardless of age, health, meds, etc. with any possibility of head trauma gets CT scan of the head, and admission for serial neurochecks/CT scan(s) if there are the smallest possibility of anything going wrong. Meanwhile, the hospitals' revenues grew up quite a bit, there were more patients and families delighted to getting that much attention, doctors are getting more practice (and money), so everybody are happy for now... except for us here, or so it looks like:yes:

cardiacfreak, ADN · Mar 1, 2015

What would you have done with a patient who is normally A&O and not palliative? I can't imagine keeping a family member home who is newly altered.
Well, I have had families who delay several hours after patient becomes altered and by then they're septic. As a rule, we don't manage sepsis at home.

If a pt is septic I totally understand admission, but, that doesn't warrant stroke protocol.

Kooky Korky, BSN, RN · Mar 2, 2015

Our system is Broken!
MD and hospital are afraid of lawsuits
Of course this is absurd!
Once again the USA rears its head as a toddler when it comes to healthcare.

It's due to insurance instead of a national health service. Health care should not be a business, nor afford anyone to become wealthy (pharmaceutical houses, doctors, DME sellers, anyone).

Fruit Sucker · Mar 2, 2015

Homeless people with foot problems secondary to not ever washing.

PMFB-RN, RN · Mar 2, 2015

Admitted overnight because they don't have a ride home. Happens sometimes in the rural hospital where I work casual.

nurse2be13 · Mar 2, 2015

I've seen a constipation admission before - also "abdominal pain" - CT negative, CXR negative, troponin negative WBC WNL- admitted for pain management - which means Q2 dilaudid with 10/10 pain while on the cell phone, tablet etc and asking for the internet password

You can't be on your cell phone if you're in pain?

calivianya, BSN, RN · Mar 2, 2015

If a pt is septic I totally understand admission, but, that doesn't warrant stroke protocol.

This reminds me of one I had once. The nursing home thought she had a UTI so they called the ambulance. The paramedic asked her to squeeze his hand and she did not, so he called in a code stroke. We gave that woman tPA and everything. The neurologists at that hospital would tPA absolutely anyone. I'm surprised I never saw them come in during a code and administer tPA just in case. I was doing q30 min NIH scales on her... and she was in her 90s with dementia. She never squeezed my hands all night and never raised any of her extremities off the bed to command. She fought like the devil whenever we tried to turn her, though, so I was able to determine that all of her extremities worked just fine. She scored very poor on the orientation, ID'ing the pictures, and repeating words after me also, which was hardly surprising because she was NONVERBAL at baseline.

It is amazing what we will put people through for no reason.

Libby1987 · Mar 2, 2015

If a pt is septic I totally understand admission, but, that doesn't warrant stroke protocol.

Ah, I thought you got her as overflow.