97 | Drs. Sean and Adam | Difficult admissions | What admissions do and do not accomplish | Group culture | Obs vs in-patient status | How we can help the hospitalist from the ED

The difficult admissions are the generally weak, unable to walk with no acute findings. They typically do not uncover any acute findings while in the hospital

In the ED, we can probably do a better job of involving some of our resources like social work to really give the patient and their family a better understanding of what admission will and won’t accomplish for them

Part of the America culture does put us in unique situations as the elderly often do not live with their children anymore. Family live far apart and often cannot help each other when in need

No one blames the patient for the situation they are in, but we want to find the best solution to serve them

IM deals with the limitations of insurance much more than we do in the ED

Ultimately, each hospital group needs to establish a culture. What would you want done for your Grandma?

A little more work now on these difficult cases in the ED can have the downstream benefit of keeping admission beds open for your next shift

Dementia patients with progression of their disease process can be tricky to disposition as well

We don’t do the best job in our society of talking about the normal aging process and how to preserve our patient’s dignity and sense of self in that process

We are scared to death of death

What is the difference between Observation admission and Inpatient admission?
 The care is the same regardless of the admission type

An observation admission is best thought of as a problem that could likely be handled in the outpatient setting if the patient had unfettered access to follow up to PCP and specialists

In-patient implies that they need resources only found in the hospital

In-patient vs obs can change over time, if nothing new is found, these statuses can change

Sean recommends the book Same As Ever by Morgan Housel 

He talks about the changes in medicine being so gradual that they don’t make headlines, but they are dramatic over time none the less

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Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.