By Deb Ault
Patient calls the AIMM nurse because she is in the ER. This doesn’t require precertification but the nurse asks a few questions about what landed her in the ER. She begins to tell the nurse that they want to admit her, but they don’t have any beds. They told her that she would have to be admitted in order to get an MRI because they “don’t do those for ER visits”. They told her that if they can’t find a bed for her, they would have to transport her to a different hospital via ambulance to have the MRI done and be admitted.
HOLD UP! WHAT?!?!
The nurse calls the ER and speaks with the ER nurse. What in the world are you guys doing?
1. Why does a patient HAVE to be admitted to get an MRI- this is ludicrous.
2. Her insurance will probably NOT pay for an ambulance ride to a different hospital when this hospital is perfectly capable of performing the service. They just have a stupid policy.
3. If this isn’t truly an emergency, why are you keeping her there and giving her the option to sign out AMA and go someplace else?
During the follow up call to the patient yesterday she tells us that 10 minutes later they were taking her to get an MRI!
Unfortunately after the MRI she still had to be admitted to the hospital for one night – they had to get the pain under control. The pain that was being caused by HER NEWLY DIAGNOSED RARE FORM OF LIVER CANCER FOUND ON THE MRI.
(Probably would have been a two night hospital stay if they’d have been able to delay doing the MRI.)
BTW – the geographic area where this patient is located is “an independent provider desert”. There are no independent imaging centers within hours of where she is. That is why we pushed to “just get it done” rather than pushing for them to write an order and let her get the imaging outpatient elsewhere.
We are now working on getting her connected to a specialist who deals extensively with her rare form of liver cancer.
Her pain is controlled and she is home – scared, but home – and appreciative of the help and open and receptive to help connecting to the expert even though that will require travel.
THAT IS WHAT PATIENT ADVOCACY BASED MEDICAL UTILIZATION MANAGEMENT DOES.