Ordering DME in the ED

[moffist]

Our hospital is piloting having RN case managers in the ED. Yesterday for the first time I had to order a hospital bed and wheelchair for a Medicare patient. This was an unbelievably difficult procedure ending in failure. There MUST be a better way than having to get our all ready overburdened ED doctors to write a great long progress note for these patients NOT being admitted. Anyone know of a form that has been developed OR an easier way than having to write a "story" for Medicare??? It doesn't help an already overburdened ED OR help the patient very much!!! Any advice appreciated.

[toomuchbaloney]

Why would the ED be responsible for the primary care of the individual? It seems to me that the ED case manager would be responsible for coordinating with the PCP or specialist who is responsible for the ongoing care to obtain that equipment rather than with the DME provider. There should be a mechanism to obtain a basic wheelchair for a patient just as there is to get them crutches, it seems. A bed is quite another matter, in my view. That suggests to me that the patient might be well served by considering a HH referral.

Am I missing something?

[moffist]

We were discharging to an ALF but patient was unable to get in and out of a normal bed. Needed a hospital bed temporarily. For a safe discharge we needed to order a bed to be at the ALF before the patient arrived. BUT with the new CMS rules I had to get a very busty ED doctor to write a long progress note ONLY to be told by DME company that it didn't make criteria. Spent hours on something that should be so easy!!

[Altra, BSN, RN]

I know you're just trying to do what's best for the patient, but that does not sound like a good use of ED resources. A patient with new onset limitations to mobility can probably get a 23-hr. obs admission while the home environment is addressed.

[Esme12, ASN, BSN, RN]

I know you meant busy ED doc....but the thought of the busty one having issues was comical in my mind.

Many facilities are doing 23 hours obs in clinical decision units with a OT/PT eval to orchestrate these things...we leave it to case management

[moffist]

Lol yes I meant busy!!! I am a Case Manager. These are patients that do not meet criteria to admit!!! 23c Obs not appropriate

[toomuchbaloney]

Lol yes I meant busy!!! I am a Case Manager. These are patients that do not meet criteria to admit!!! 23c Obs not appropriate

Please explain how they do not meet criteria for 23h Obs.

Needing a hospital bed is not an urgent need and doesn't require the efforts of the ED staff/MD to secure it, in my view.

[MunoRN, RN]

Lol yes I meant busy!!! I am a Case Manager. These are patients that do not meet criteria to admit!!! 23c Obs not appropriate

I'm having a hard time imagining some sort of situation where a patient would come into the ED and end up requiring ALF placement and a specialty bed that wouldn't also qualify for an obs stay, or at least to be managed by a non-ED physician, and I would think they would also require a PT/OT eval to qualify for a specialty bed.

[moffist]

First this was a chronic condition. Secondly her pain was controlled by po meds. She needed the speciality bed because she was unable to get out of an ordinary bed easily. MD decided HH then OP PT was all she needed.

There is no such thing as a 23 hr Obs admission. Dealing with Medicare denials on a daily basis this was absolutely prime to be denied.

[Altra, BSN, RN]

First this was a chronic condition. Secondly her pain was controlled by po meds. She needed the speciality bed because she was unable to get out of an ordinary bed easily. MD decided HH then OP PT was all she needed.

There is no such thing as a 23 hr Obs admission. Dealing with Medicare denials on a daily basis this was absolutely prime to be denied.

No such thing? That would surely be news, as every facility in my multi-hospital system has a medical short-stay or observation unit.

However, now that you explain that the patient's pain is chronic and controlled with p.o. meds, I am not surprised this went down the way that it did. What was the reason for the ED visit? A fall? Have there been multiple falls? Ambulatory dysfunction or some similar dx could admit the patient for 23 hrs., particularly if there are lab abnormalities and/or evidence of altered mental status. Otherwise, this is a patient who needs care coordinated by the PCP, not the ED.

[Esme12, ASN, BSN, RN]

I am SO NOT case management..this might be better served being answered in the case management forum....thread moved.

[SummerGarden, BSN, MSN, RN]

I work in EDs and I order DME all the time. The process is not that bad and does not require a patient to be admitted to the hospital for any reason to include placing him/her on OBS.

Basically, if the patient has insurance and there is a documented safety and medical need for the equipment, the DME can be ordered the same day to be delivered to the patient's home or the ED and the insurance can be billed directly by the company. If the patient has no insurance and/or no medical safety need for the equipment, then he/she has to pay for the equipment out-of-pocket. There are plenty of places for people to go to get the new equipment when insurance will not cover the equipment, such as drug stores and DME companies found in the local phone book.