Re: TAH Length of stay
From: art fougner, md (evsono@pipeline.com)
Wed Jan 16 11:49:16 2002
again the other point was the need or lack thereof for premedication -
interesting how practice patterns vary.
perhaps this might be the subject of a cochrane review?
art
At Wed, 16 Jan 2002, Jay Kulkin wrote:
>
>This is a great approach and the reality is most patients will be ready clinically and those that are not will have a clinical need to stay. The thread on not using catheters so long is a great tool. We removed catheters a couple of hours post op in C/S and hysts for several years and found much earlier ambulation, a feeling of wellness and earlier eating and D/C. Less than a 10% re-cath rate during the night but a prn order left for the nurses avoided the phone calls.
>
>JK
>
>--
>Jay M. Kulkin, MD MBA FACOG
>Women's Health Resource Associates
>3475 Oak Valley Road
>Suite 2640
>Atlanta, Georgia 30326
>404-841-0034
>Fax: 404-841-0054
>
>>> ----- Original Message -----
> From: Myer S. Bornstein, MD, MMM, FACOG, CPE
> To: Multiple recipients of list OB-GYN-L
> Sent: Wednesday, January 16, 2002 10:58 AM
> Subject: RE: TAH Length of stay
>
> I still get a 3 day LOS for an Abdominal Hysterectomy from most of my patient's insurers.
>
> We must remember that WE!! are the people responsible for the care of the patient. Each patient is an individual and must be treated as alone. When I discuss surgery, start then on expectations for the patient, when they will ambulate, that they will be fed the day of surgery and when they can expect to go home. The majority of my laparoscopic hysterectomies and vaginal hysterectomies are discharged the day after surgery, and most abdominal hysterectomies (all the above uncomplicated) the second day post operatively. But, I do not decide at 7 AM if the patient can go Home, I will check them at 12 noon and 5 Pm to decide on discharge. This allows me to see how they are doing with eating ambulation and pain control. My LOS is determined by the patients' condition, Not the insurance company
>
> Myer
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Jay Kulkin
> Sent: Tuesday, January 15, 2002 10:59 PM
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: TAH Length of stay
>
> If it is medically necessary establish it in the medical record. Having just left the health plan side I can't tell you how many times the nurses notes say the patient is fine and could leave at 5pm and the doc's notes says very little at 7am that same day. In addition, many docs make rounds earlier in the am when one would not expect a patient to look ready for d/c but by 5pm they are. This is what managed care plans look at. I do not under any circumstances understand a TAH being d/ced by guideline in 24 hours. I've seen a few patients request d/c this early but it sure is rare.
>
> Jay
>
> Jay M. Kulkin, MD MBA FACOG
> Women's Health Resource Associates
> 3475 Oak Valley Road
> Suite 2640
> Atlanta, Georgia 30326
> 404-841-0034
> Fax: 404-841-0054
>
>>> ----- Original Message -----
>
> From: Gordon
>
> To: Multiple recipients of list OB-GYN-L
>
> Sent: Tuesday, January 15, 2002 10:43 PM
>
> Subject: Re: TAH Length of stay
>
> You are both wrong, the only one authorized to make the discharge decision is you and/or the patient. If she wishes to be discharged because of economic pressure from the hospital or insurance company, she will have to sign out AMA, unless you concur. The alternative is for her to dismiss you from her care and let the next physician sign her out.
>
> Gordon M. Goldman, M.D., FACOG
>
> Private Practice, St. Louis, Mo.
>
>>> ----- Original Message -----
>
> From: RModugno@aol.com
>
> To: Multiple recipients of list OB-GYN-L
>
> Sent: Tuesday, January 15, 2002 9:06 PM
>
> Subject: Re: TAH Length of stay
>
> In a message dated 1/15/02 9:53:05 PM Eastern Standard Time, evsono@pipeline.com writes:
>
> if you medically think this is unsafe then don't discharge - rather ask
> the insurance medical director to come write a note on the chart to that
> effect.
>
> They won't do that, but the UR nurse from the insurance company does!
>
> Robert Modugno MD MBA FACOG
> Marietta, GA
>
--
art fougner, md
ich bin ein New Yorker
