Magazine article American Nurse Today

When Cost-Cutting 'Rules' Cost Patients

Magazine article American Nurse Today

When Cost-Cutting 'Rules' Cost Patients

Article excerpt

Thom Newsom, MSN, RN, * was not given to hyperbole, but in all honesty, this situation was crazy. His next-door neighbor, Mary Bremant, a 63-year-old woman, complained of acute abdominal pain. Newsom took her to the emergency department (ED) where she was medicated, referred to her family physician, and then sent home. Two days later Bremant returned to the ED, again complaining of acute abdominal pain. Although she had a history of indigestion, gastritis, and reflux, the ED physician admitted her to the hospital's cardiac care unit (CCU). Her ECG was normal, and she was discharged to her home. The next day she visited her family physician in his office. After examining her and studying her history, he concluded that she probably had gallbladder disease, ordered a gall bladder function test, and referred her to a surgeon.

Bremant, on the advice of her family physician, went on a low-to-no-fat diet as she awaited the results of her test and her appointment with the surgeon. After reviewing the test, the surgeon said Bremant's condition was not severe enough to warrant surgery; it indicated her gallbladder was functioning at 33% efficiency, and the guidelines placed the cut-off for surgery at 30% efficiency. He ordered some anti-anxiety drugs for her and sent her home.

Two weeks later, Newsom took Bremant back to the ED. She was admitted again and sent to the CCU. She tried to refuse a cardiac catheterization, insisting that her heart was fine, but she was told that no surgeon would operate on her unless she had the catheterization to rule out heart disease. So, she submitted to the procedure; it was negative, and she was sent home again.

Newsom, concerned about Bremant's condition, urged her to call her family physician for another appointment. She said, "What's the use?" As it happened, Newsom knew this physician personally and spoke to him about his concern for Bremant. The family physician agreed to see her and had his receptionist call her home to schedule an appointment. At the visit, it took him only a few minutes to identify jaundice and conclude that her problem almost surely was her gallbladder. On the basis of his exam, he called the surgeon, asked him to reconsider his decision not to operate, and made an appointment for her that day. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.