Scenario: 66 yo male with a recent history of severe blood clotting causing hospitalization in the ICU for 3 weeks, pulmonary embolism, and the amputation of one leg below the knee. Patient has been discharged and living at home caring for self for past 6 months. (all within same year)
Patient recently fell due to poor weather conditions. The patient experienced a fracture of the hip as well as a fracture of the femur in the amputated limb. Due to previous history it was recommended to transfer patient from local hospital to a larger facility.
After 3 days, many phone calls, various referrals to orthopedic surgeons, and rejection by 5 hospitals, the local facility was able to find an accepting hospital willing to take his case.
I was asked why was it so difficult to find a place to take him? Was it due to the clotting? Was it due to his history of pulmonary embolism? Was it due to the complex resources?
I asked which hospitals his local care team reached out to make transfers?
The referrals were made to the following: (3) Level One Trauma Centers, (2) Level Two Trauma Centers, and (1) Level Three Trauma Center.
The facility that finally accepted him for care and he was transferred to was a Level Two Trauma Center. (number 4 on my map)
Even with a well documented and recent history and physical, a thorough diagnosis (obviously I did not include everything), and a well engaged patient, his experience is less than perfect.
As a matter of fact, the patient was transferred to the hospital furthest away from his home, his support system, and family. It also happens to be a facility that is not the highest level trauma facility.
In the above type of situations we usually are not in the capacity to drive our own care. We usually are at the mercy of the healthcare system to plug us into the right facility based on our diagnosis.
In the above scenario, I question if each facility made their decisions based on what was best for the patient, or did they also consider their own self interests? Did the risk for complications, readmission, ICU, length of stay, and other scenarios play into the decision? Did the risk for reimbursement and penalties impact their decision to accept or pass on his admission? Did the facilities decide on their ethics?
All I can do is be thankful that a facility admitted him, know he is in good care, and other than the initial wait and long ambulance ride, his overall patient experience is good to this point.
However, his healthcare experience outside of the hospitals walls is poor.
Feel free to comment and add your own perspectives and questions.
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