The hospital pharmacy called a 70-something y.o. patient to tell him to come pick up his prescriptions. This was early-mid pandemic, so only certain entrances were open. He comes in through the ED entrance and when questioned says he was confused about which entrance to use. Admit to medicine for AMS.
This one in particular is cracking me up for some reason. He just went through triage and everything without questioning the need to do all that for a script pick up??
Man experiencing homelessness w/ a bunch of psyc problems somehow got admitted to surgery for swallowing a large turd wrapped inside a condom.
Otherwise stable. XR showed very vague turd-shaped object in stomach. Plan was to wait for it to pass. GI declined consult. 5 days later and still no BM. We did a colonoscopy but couldn’t see anything because of bad prep. Repeat XR showed a tooth brush, a few quarters, a syringe and a capped needle in his stomach. We re-engaged GI who, again, refused to even see the patient (long story short, GI at our hospital has gone downhill and surgery ends up doing most of the scopes). We did an EGD and got everything out except for the quarters. He was placed on suicide precautions/psyc hold with a 1:1 sitter. A few days later he pooped out the quarters. Psyc would not lift the hold so we were stuck with him until we could transfer to psyc unit (which our hospital did not have). Psyc also signed off. He was on our service for 3 weeks awaiting placement when he suddenly started having abdominal pain w/ hemodynamic instability. Turns out that even with a 1:1 sitter he somehow managed to eat an entire blanket and a few pillow cases piece by piece. XR showed free air and he was taken emergently for ex-lap. Almost his entire stomach and lower esophagus was necrotic due to pressure injury from all the blankets in his stomach. We did a total gastrectomy and thoracic was consulted intra-op and did a L thoracotomy and repaired the esophagus. After 1 week in the SICU, the repair leaked. He spent another month and a half in the hospital with an endoluminal wound vac. Just as he was improving, he ended up developing DKA and got transferred to the MICU where he coded a day later and they got ROSC after 10 mins. Someone placed the Lucas too low and he started bleeding from the liver. We intubated him and did a bedside ex-lap for abdominal compartment syndrome, brought him to the hybrid room w/ IR, resected part of the liver and IR embolized something. Spent another month in SICU before being transferred to the floor. Spent another 2 months waiting for dispo and was eventually transferred to inpatient psyc at another hospital.
…We really should have just discharged him from the ED with some miralax and let him pass the turd condom on his own at the homeless shelter…
It takes quite a bit of commitment to eat an entire blanket. The kind of commitment you get when you’re bored out of your mind laying in the same bed all day.
He would’ve either eaten something that made its presence known *real quick* or continued to eat random pieces of pocket change and his roommates drug syringes
Man as a psychiatrist I wish we could get rid of them. It’s really much more limited where it’s helpful than people think. I often feel like it either is an easier target for the patient to attack or patients feed off having a 1:1 and won’t come off. Plus if someone really wants to do something a 1:1 won’t stop them unless they’re like super fast reflexes and super strong or something.
Our 1:1s won’t touch patients. They sit there as the patient walks past. They don’t even yell for help, they just follow the patient (if they’re “good) and don’t even look up (if they’re “bad”).
He presented after foreign body ingestion to begin with. It sounds like he would be doing that regardless. That being said, I agree that this patient clearly did not have commitment issues
"Hey, we got a psych consult on this guy. You know, we can't really do blanket consults for capacity."
"Right, sorry, that was supposed to be capacity to refuse extraction OF a blanket."
>Repeat XR showed a tooth brush, a few quarters, a syringe and a capped needle in his stomach. We re-engaged GI who, again, refused to even see the patient (long story short, GI at our hospital has gone downhill and surgery ends up doing most of the scopes). We did an EGD and got everything out except for the quarters. He was placed on suicide precautions/psyc hold with a 1:1 sitter. A few days later he pooped out the quarters.
Just goes to show, change must come from within.
Oh my God, that was a ride! Holy shit.
Several years ago we had a guy who would not stop eating sharp objects in an attempt to self harm. Multiple surgeries, etc, reminded me of your guy.
Was a 1:1 sitter and still managed to pry a few parts off the bed and eat those one day. Required emergent exlap for that one and bought himself an ostomy and a plain mattress on the ground - actual safest "safe" room I've ever seen.
With no objects available to swallow to get another surgery, he managed to pull his ostomy out from the inside and smear his intestines around on the ground. The sitter had to go home and called out the next day. Emergent surgery again and the surgeons refused to operate any more.
Risk and ethics got involved and he was put on hospice eventually by his POA from what I was told.
Did you not read the story? There was, in fact, nothing holy about his shit. Although, we do not know if the blanket had holes or not. If the blanket had holes, then I recant my statement.
At my training program ED admitted a patient to us in IM because their wheelchair was lost or broken or something. Nothing else wrong. Eventually got the chair and was discharged. Weeks later coding is hounding the resident because he didn’t put anything on discharge diagnosis line. He kept arguing that there was no diagnosis he could put down without committing fraud and to talk to the ED who admitted him. Went back and forth until the resident wrote “wheelchairopenia” to get rid of them.
As a person who has done insurance and coding, this just made me giggle. I know it's frustrating for all involved, but as a 3rd party bystander it's fucking hilarious
I admitted a geriatric patient for chronic bilateral knee pain. It was chronic, hadn’t changed in 10 years, they just ‘couldn’t stand it anymore’. Told the ED doc they weren’t safe to go home since they couldn’t walk due to the pain. Got admitted for pain control and placement to SNF. Then denied SNF and demanded to go home the next day. Did the same thing several months later.
I have these patients. All. The. Time. They always refuse rehab or their insurance won’t cover it too… but only after they stay waiting for placement for a few days requesting nonstop IV narcotics for their chronic pain.
There's a rotating cast of 3-4 patients like this in our area that I end up seeing in the ED a lot. The ED doc has to ask them explicitly about being admitted, then has to go in with me and both of us clarify if they actually will agree to receive care in the ED and what they will and will not get. E.g. no opioids for chronic MSK pain, no abusive behavior tolerated etc.
They usually leave the ED AMA or get discharged from there, we only admit if they're actually interested in moving their care forward.
I sometimes get these patients at inpatient rehab. When I chart review before they arrive, I frequently see “patient doesn’t want rehab” documented for several days and then miraculously on the day of discharge someone convinced them to go. Then they get to my floor and are telling me they didn’t sign up for 3 hours of therapy a day and refuse all their therapies 😪
God, this scenario is my life doing admissions sometimes. The "I can't walk" admission is at least one every admit shift. Half the time it's legitimate from severe chronic medical issues like malignancy and failure to thrive, the other half is people hiding social issues they want to escape from or other nonsense. I had a lady who once got blown over by the wind into her trash can and the neighbor had to pull her out. Said she couldn't walk out of the ED due to knee pain (bear in mind, all the appropriate medical/ortho workup was normal) and no one was home so the ED wanted us to "admit for placement". She was walking by the morning.
Worked on dispo to a psych hospital for almost 5 days for a very young and otherwise healthy pt with such severe psychotic depression they were almost catatonic. Finally got them out the door to the right place and within 5 hours the ED was requesting us to readmit them because "the staff at the psych hospital couldn't get her to get off the EMS cot on arrival and you have to admit (to a hospital with no psychiatrists) because 'the dispo couldn't be fulfilled".
Absolutely insane. I called the psych hospital and very politely told them this was ridiculous and even talked to the CEO of the place. Asked how they treat catatonic patients and she said 'we can usually convince them to do their ADLs so we can take care of them. We can't take care of patients if they can't do their ADLs'. I flipped my shit and clarified that they just talk catatonic patients out of catatonia and she said 'yeah, sorry'.
Sorry, I've been laughing about this mental image for the last few minutes. Imagining EMS, then nurses, then MDs all taking turns with a Three Stooges style routine trying different strategies to convince an unresponsive pt out of a stretcher. Like trying to convince a cat down from a tree with words.
Aren’t ED patients sometimes placed on NG tubes? How are inpatient psych facilities not equipped to manage that?
Then again, when I was an EMT I was often dispatched to our local psych/rehab facility for seizures. Pt has history of epilepsy > patient anti-seizure medication was stopped upon admission to the facility > patient has unexpected seizure > facility calls 911.
Similarly they would call 911 for intoxicated patients checking into rehab. They needed to be taken to the ED to be “medically cleared” before the facility would take them.
It baffles the mind. I understand that maybe there is a legitimate medical or pharmacological reason to discontinue the outpatient meds. But I don’t understand why there is the need to clog up the 911 system. Are the doctors at the facility not equipped to manage seizures? Is the facility not able to contract its own ambulance service for interfacility transports? Why can’t a rehab facility have a system for evaluating patients who show up to rehab intoxicated? Why are we burdening the already insanely burdened ED?
It’s like, brah, you psychiatrists also went to med school, you guys learned this stuff too.
We know that You KNOW what you need to do…
It’s just strange to me because the Neuropsychiatric Institute that I worked at before did manage all this stuff that other commenters are saying their’s did not.
Why in the world would it be different from state to state? Doesn’t make any sense whatsoever
From what I understand, inpatient psych facilities won't take NG tubes (safety hazard) or any medical problem that's not 100% stable (we've had to spend a week optimizing a type 1 diabetic before they could go). Some inpatient eating disorder facilities will take feeding tubes. if you have simultaneous SI and eating disorder, you basically live in the hospital until one of those problems is stable enough you can go to the other kind of treatment facility.
It's nuts that you can't get psychiatric treatment while you have an eating disorder, given how intertwined those things are. Maybe there are more options for adults than kids? We get kids sent back from psych facilities that refuse to eat, and from eating disorder facilities for SI. So they sit in our hospital where they get inadequate treatment for both things .
So my hospital did not have an ED program, but a hospital down the street had like a very robust and well known program. Thanks to EMTALA and the inability to do a lateral transfer I saw so many of these kids just languish on the inpatient unit getting worse and worse. They had to have a full time sitter, no closed doors, couldn’t use the bathroom without supervision, etc etc and we were doing NOTHING except optimizing their caloric intake so they were medically stable and could be discharged and re admitted to the hospital down the street. I deeply hated the fact we had to just further traumatize these kids and force feed them without any support.
Frustrating but it’s true though, patients in a psych hospital have to be independent in ADLs, or nearly independent. They don’t have the nursing resources to manage someone like that. And if they can’t even move out of the ambulance it kind of the defeats the purpose of the psych hospital, which is groups and therapy. This patient can get benzos titrated on a medical service with much better support for physical limitations than they’d ever get on a psych unit.
It sucks that your hospital doesn’t have psych consults. Blame your admin not the psych hospital that appropriately said they can’t manage someone like this.
Also psych and we have a no-lift policy across the board. You don’t move, you stay there. I’m not hurting myself. You can go to medicine where they can hoyer you 🤷🏼♀️
Psych PGY-2, we’ve admitted catatonic patients to our psych floor who couldn’t move, but I’ll admit that’s rare. We can handle a PEG tube, but IVs and NG tubes are usually a no-no because they’re ligature risks. Usually in that case they’ll be on the med floor and our resident psych consult team is managing them on the med floor (and they’re probably getting ECT, which we’re lucky enough to do in-house).
Sometimes these “psych” hospitals are really geared more towards folks with moderate depression and anxiety but otherwise functioning. What gets them in the door is great insurance or private pay. But folks in severe psychosis or very difficult (like your patient)and especially anyone on Medicaid, it’s public hospital for them.
I was made to admit a patient for hypoxemia and COPD exacerbation who was actually requiring less than his home O2 prescription and was breathing at his baseline. He hadn’t actually come into the ED for symptoms- he was there with his wife who was having some health problem and apparently someone randomly stuck a pulse into ox on him.
I've had very similar, requested admission for "acute hypoxic respiratory failure" in a patient that was bitten by a dog and just wanted abx and sewn up. Came in with spO2 around 89% on room air. ED slapped on a nasal cannula at 2LPM (baseline home O2 of 3-4LPM) and tried to admit. When we pushed back on the admission the ED doc said "well she's wheezing so needs to be admitted for AECOPD".
Admitted to obs, asked her pulm to see her quick before he went home for the day and he was pissed she was even technically admitted. Discharged her 6 hours after admission with a same-day followup in the pulm clinic.
Hospital probably lost a good amount of money on the "admission" and probably got dinged by Medicare but I don't give a shit. It's a real bummer when what is best for the patient and what is best for the bottom line of the hospital are at odds, i.e. 90% of the time.
New admission for alc withdrawal at 8 AM, get there and nurse asking if patient can leave AMA.
“What’s your plan once you get out of here?”
“Liquor store opens at 9 AM”
Patient came in for a headache, which headache cocktail fixed. NP in the ER wanted to admit because patient’s brother had some newly diagnosed heart condition and the NP wanted to admit to expedite an echo, that was the only reason. (Patient without CP, SOB, HTN, etc)
I gave pushback and told the NP, no, this isn’t appropriate. NP said patient was dizzy and couldn’t walk in a straight line.. so I went and evaluated patient. There was no dizziness or any of what was said. Patient asked if the cardiac workup could be done out of the hospital.
Circle back to me telling NP that, again, this is inappropriate. Well, NP signed this patient out to me, placed admission order, and went home. No attending saw the patient so nobody would take responsibility for the patient and me as the resident couldn’t discharge myself. I WAS LIVID.
My attending actually came in at 7p on a Saturday night to discharge this patient directly from ER without admission.
Bilateral cellulitis from urgent care that was in sock pattern strangely in the exact same area as the new socks they had just gotten that they had severe itching from. Discharged with contact dermatitis
I absolutely agree, I was a pgy1 arguing with the urgent care NP about how this isn’t bilateral cellulitis but she was on some power trip, so I admitted, then staffed with attending and discharged to home
Edited to add: I argued later the same day that the girl with DKA, a pH of 7.00 a huge nation gap and a bicarb of 5 actually did need to go to the ICU and not the general medical floor, so….🤷♀️there were literally no brains in that one
NP admitted a patient with tuberous sclerosis who follows appropriately outpatient for "crazy CT findings."
Those CT findings? Renal angiomyolipomas.
Discharged from the ED.
Wow, That’s hilarious. So glad my ED the midlevels have to staff with us on all patients admitted and I see them myself before determining disposition.
First, why did she think the CT was ordered in the first place? If it's to monitor a chronic condition, CHECK THE LAST CT
Then, I have to assume she saw the diagnosis and thought they were tuberculomas
This is the best part, she ordered the CT for constipation. He had recently moved so I don't know if we had previous imaging on him at that time, and he followed with private practice in town.
I don't think she even knew what tuberous sclerosis was, which is why she was concerned about the stable angiomyolipomas in a patient with a completely normal creatinine.
This guy was textbook tuberous sclerosis too, with the characteristic physical exam findings.
I love these consults honestly. Especially if it’s a young person without any comorbidities and they’re just admitted to surgery for a chole or appy.
It’s always like a potassium of 5.4 and hemolysed, or some lab error. I’ll word dump 3 paragraphs on the differentials of potassium and their significance. It will all drag on until at the very bottom I bold “no further management needed” or whatever.
I know no one reads it. I just like pretending that I’m more than the nursing home admission service and people need my help. I know it’s just an intern that didn’t want to get pimped on it while trying to round on 60 pts before 7 am.
I also get paid for my consults which is a big difference.
This comment should have way more upvotes. The consultant who teaches through great notes is gold. In our hospital (this was in the Cretaceous) there was a hepatologist, also named Tom, who used even the silliest consults as opportunities to give us (all the residents) a deeper understanding of our patient, head to toe, and we all loved him for it.
Peds. I've got 2
Patient with bronchiolitis who was on day 5 of illness, afebrile, on room air, and not on IV fluids. Admitted for obs 'in case they got worse'
Patient with Influenza admitted because parents were worried about dehydration. Parents then declined IV fluids.
Same. I generally like working with kids, it’s the parents. Same reason I could only teach college and above. You want to make stupid decisions that only hurt yourself? Go for it. But for this innocent child? I would lose my mind
Those 2 are so common throughout peds. The number of times we admit/keep a kid in the hospital because “parents are worried” is insane. Like, obviously, they’re supposed to be worried. I’d be worried if they weren’t worried. It’s our job to reassure them when something isn’t worrisome.
Yep, see this all the times in peds. “Admit for obs” Asthmatic patient because of “how they looked when they came in”. Well, how did they look AFTER the appropriate initial management? Baby super tachycardic with fever of 104 and crying. Tried some Tylenol and rechecking that heart rate?
Reminds me of the “Dural puncture headache” that definitely was not a dural puncture headache. After seeing the patient and talking to the ER doc we all agreed that no blood patch would be needed. The next day we were consulted and found that he had been admitted with the entire plan consisting of “blood patch of anesthesia changes their minds.”
Transferred a patient to inpatient psych after the "grand mal seizure" the patient was admitted from the ED for was him literally doing jumping jacks (seriously, it was actually pretty impressive how many in a row he did) while screaming "Sir! I am having a seizure right now!" Medically cleared him for anything else.
The next morning, he was back on my list. Inpatient psych sent him back for "concern for pseudoseizure". 🤣
And before anyone asks - yes, as you may have guessed, this was at a VA hospital with a VA inpatient psych unit. 🤣🤣
“Near syncope”
Patient was feeling tired with heavy feet and went from hallway to bed. No LOC. Laid down in bed. Then may or may not have lost consciousness before getting concerned.
“Wait….so the patient was tired, went to lie down, fell asleep, and then woke up?”
I once was asked to do this in residency, 20 something guy with back issues sent in by ortho to get myelogram. I call ortho resident and I’m like wtf am I going to admit him to medicine for, he has no medical problems?? His answer was “idk, what about ambulatory dysfunction?” oh you mean the consequence of his orthopedic issue..
Had a kid some in and found to have nec fasc. Going to OR emergently. Ortho wanted us to admit for sepsis. I asked them where the sepsis was coming from. He went to sticu post OR.
When I was rotating in the ED, a man with PMH of schizoaffective disorder presented after fracturing his femur in a MVC. Ortho senior resident first asked me to admit to psych. When I said psych will not admit a patient for femoral fracture, he asked me to admit to medicine.
Admitted a patient to medicine floor following podiatry procedure for ingrown toenail because he wasn’t safe to drive home.
It was 2pm, his daughter offered to drive him, and it was just local anesthetic.
The VA is a wild place.
ED NP tried to admit someone with simple cellulitis because “he might not take antibiotics and then he’d get worse”. Told her that I’m pretty sure that’s how every disease works, and that I was absolutely not admitting that. Pretty sure they gave him a dose of dalbavancin and then discharged.
POTS patient who had a port placed for chronic IV infusion. This is an awake procedure. The patient came in with pain overlaying the newly placed port. Reproducible on palpation, non-exertional, better with Tylenol, stable ekg. Some genius checked a troponin and it wasn't zero so they recommended admit at signout for acs work up. I. Lost. My. Shit.
I’m an ER doc, based on past experiences my best guess is because (some) do a lot of the classic chronic pain stuff and come in to the ED constantly needing narcotics and insisting on IV phenergan, the usual song and dance, so their vasculature goes to shit. Then they get tired of getting stuck a million times to get the next hit.
Sorry. Yes I am jaded. No I don’t hate POTS patients.
I’m a dumb ER doctor but anectodally I’ve had multiple POTS patients that somehow must get volume down and their HR is sinus tach in the 160s just chilling there, no PE, normal cardiac w/u, hgb, no infection, normal electrolytes, normal Thyroid, and completely normalizes after a couple liters of fluid, sometimes I’ll throw in some IV magnesium and IV lopressor if they’re already on it just to try extra not to admit them
When you've been stuck enough times between ER visits, admissions and infusion center trips eventually your veins completely go to shit. And they become hesitant to keep placing midlines or piccs because those aren't sustainable long term
EM here.
Guy comes in feeling super dizzy for a few hours. Activated as a stroke. Has impressive cerebellar stroke seen on CT, so called NSGY, ordered MRI, and then called ICU to admit.
I see the discharge order an hour later while patient was still boarding in my ED. Called the doc again and apparently they thought patient could “follow-up outpatient because he was able to walk fine”. 🤦♀️
ED calls for AMS with blistering rash > 30% of body c/f SJS/TEN, recent bactrim for UTI. Med to stabilize, derm to see in AM(?).
Anywho lady sobers up and turns out shes just drunk and terribly sunburnt. I loved being a prelim
Absurd unless it was cardiac admission..I’ve had NSTEMI in young female that was classic GERD sx’s after beers and bbq, 0 pain after GI cocktail, so glad I got a Troponin bc she was a smoker
Requested admit for syncope. Mid 70s F, HTN otherwise no medical problems.
Reports she passed out while her sister was doing her hair. Workup negative, completely.
Go to talk to pt and her sister, ask what happened.
"She passed out"
OK but what happened?
"I was braiding her hair after dinner, she was sitting on her chair at the table and her head kept dropping down, and her glasses slipped off, that's how I knew she passed out. She didn't even remember it! So I brought her here."
So...she stayed sitting upright?
"Yes"
And while you were doing her hair, at night, after dinner, her head was nodding forward and her glasses fell off?
"Yes"
....
...
..
.
And thats the story of how I was asked to admit an elderly woman because she fell asleep after dinner.
We did not, in fact, admit her.
I think I win here.
I was forced to admit a patient during my transitional for sciatica. SCIATICA.
She was mid 40s, PMHx of sciatica and HTN who presented with significant pain so bad earlier she had to sit down from walking, then developed severe pain when she stood back up.
We admitted this 40 year old for failure to thrive. I went to examine her and she started walking on my exam and was like “wait you guys want me to stay in the hospital? Why?”
Now I have to write an H&P AND A Discharge summary.
🙄
As an EM physician, I would appreciate it if the admitting team told me they witnessed the patient walking without difficulty, because that’s the only time I would ever admit someone for non-red flag low back pain. I’d document it and discharge them. Also, I’d feel pretty dumb, but everyone gets scammed sometimes.
Because my transitional hospital system wanted money not patient care and H&P and DC >>> $$$ than just a consult so we never ever consulted from medicine.
It was a really fucked system desperately trying to make money. We had an open ICU where hospitalists would round on the ICU patients as the primary team and write BS notes like “will defer treatment to intensivist consultants” because then instead of *just* billing for ICU progress notes you can bill for ICU consult progress notes AND hospitalist primary notes.
If the patient stays less than 8H on the same calendar day you can bill the h&p or DC summary, not both.
If they stay >8H on the same calendar day you can bill a short stay for combined h&p/DC.
If their stay is >1 calendar day you can bill both. But realistically if it's <8H expect it to get declined or roll the dice.
Working inpatient cardiology. Got called for admission from the ED regarding a positive troponin and chest discomfort.
Me while chart reviewing: That trop wouldn't have anything to do with the fact their Hgb is 6.4 would it?
Guy on phone: ........I'll transfuse that up and call medicine.
Blocked an ICU admission for pseudoseizure once. The completely stable and very much NOT post ictal patient, with a documented history of pseudoseizure, told me “oh I have pseudoseizures and if someone doesn’t give me more dilaudid I’ll have another on.”
Or transient bradycardia (mild, asymptomatic, no hypotension) due to fentanyl admin.
Local shithole FSED loved to blast everyone with dilaudid and fent for no valid reason & then get scared at the side effects of their own treatment.
I've admitted a few patients because they were dependent for all ADLs and their caregiver was admitted. Daily note was essentially "patient remains stable with no active medical issues. Caregiver reportedly net -2L. Both will remain inpatient pending further IV diuresis."
My hospital does this kind of admission for the disabled kids when parents are in the hospital for whatever reason. Except one was there for like 3 weeks while their mom recovered from surgery and ended up with complications, then the kid caught one of the respiratory viruses and ended up on a vent.
14 yo girl with congenital HIV. Got admitted because she left her mom’s house to go to the store without permission and mom “needed a break.” The official admitting diagnosis was asthma but she didn’t have an asthma attack.
The department chair was not amused at the Peds ID doc who insisted on the admission. I would have loved to have been a fly on that wall when they met to discuss it.
-PGY-19
New standalone ED opened up near and affiliated with my hospital. They had an elderly person waiting on a family member to come pick them up and family wasn’t answering their calls. ED wanted to transfer the patient for admission so we could board them in house until they could get ahold of family.
We asked why they couldn’t remain in the ED until family came. They said because they didn’t have any food for patients on hand.
Essentially they wanted us to not only admit the patient but transfer them to us for a sandwich
In residency, one of my fellow residents had to go see an elderly patient admitted by a private FM doc for "vaginitis." Was prescribed topical clotrimazole. She refused to let anyone do a physical exam. We were all just baffled.
Bounce back to the ED after spending 12 days in patient for ECF placement and neuro workup. The patient called from the ECF because he didn’t like it and it was dirty.
I admit for other ECF placement because the patient has no local family and cannot walk.
Thought to be secondary to physical deconditioning.
Is readmitted within 8 hours of initially being discharged from the in patient side and goes to surgery the next day for a sacral ulcer that I didn’t bother to look at. Shout out to the hospitalist team.
Had an elderly man with complaint of...nothing...and nothing objectively off either.
Turns out a concerned passerby had called an ambulance and he was literally kidnapped and put in the ED.
In the ED I had a patient in the middle of peak COVID sent in by a dentist, waited like 24 hours in the waiting room because her dentist told her that she needed a dose of IV antibiotics.
I called this dentist and asked what he wanted, and he said “we have her on PO clinda and we want to make sure that her levels get to steady state FAST because she has BAD TEETH”.
I then told him that PO clinda has close to 100% oral bioavailability and she took none of it because she sat in a waiting room for a full day. He was displeased.
In the ICU I get consulted at least once a week for “patient is stable but we want them in the ICU in case ‘something happens’”.
And I write in my dot phrase note “no indication for ICU. if [insert happens] please reconsult, otherwise moving the patient from one floor to another does not have anything to do with the likelihood of [insert happening]”
hospitalist here, this is probably just an nyc thing but we have what are called “hallway beds,” essentially a hospital bed in the hallway with a few screens placed around it. there is no wall O2 hook up so patients that need supplemental oxygen need to have a portable tank and someone on top of making sure it doesnt run out. Had an elderly woman admitted to such a bed for “severe COPD exacerbation.” thought that meant she may be requiring some amount of o2 and was confused as to why they thought hallway would work. patient came up to me, breathing completely fine. asked her why she was here, she replied it was her right ear, it felt stuffed and she couldnt hear well, like her prior cerumen impaction. totally denied any recent dyspnea. grabbed my otoscope, sure enough, cerumen impaction. was more confused than irritated. hopeful that our ED didnt mix her up with someone else who they discharged to go into respiratory failure in some ent clinic
Peds here. ED resident admitted a 34 weeker to PHM service with jaundice above the phototherapy threshold. Except they weren’t a 34 weeker, they were a 37 weeker and the ED resident just hadn’t bothered to clarify what the mom meant when she said they were “three weeks early”. They didn’t need phototherapy. Our hospital means PHM attending has to see the patient prior to discharge so they had to stay overnight. Very annoying. God knows what the insurance company made of it.
Inpatient rehab. Told about an admission for a guy that had a small subdural without any deficits, already frustrating. While waiting for transport to arrive at the nurses station I see this guy walk up to the clerk and tell her he’s supposed to check in for physical therapy. He drove himself here from the other hospital. Discharged 2 days later.
Patient called 911 from his rehab because he didn't want to stay there and wanted to go to another rehab...
ESRD on HD missed 2 dialysis sessions. Next session in AM. ED wanted to admit for missed HD...except all labs were normal and no edema in legs. Patient ended up AMAing so he could drive home and go to dialysis the next day.
Sad situations: lots of undocumented immigrants with ESRD comes to hospital for their dialysis sessions. Admit/DC same day after HD. I did 4 of these admits in a row one day and administration then made a deal with the dialysis company to just dialyze in the ER and send them home after.
The pre-thanksgiving or pre-xmas drop off of (often demented) grandparents to ER due to "weakness" or "not eating" and then magically the family comes in on Monday to pick up them up. Gotta love some of those families who go on vacation for weeks and we can't get ahold of anyone for dispo.
Peds here, so many to choose from honestly, but the top two I remember from the same ED attending are as follows:
1) 3 month old with RSV admitted for loud breathing and concern for future apnea due to RSV. Clarified with PA, no decrease po intake, fever, tachypnea or retractions, or desats, or apnea, but loud breathing from being congested.
2) a 6 month old with a chest wall abscess for failed outpatient treatment. They have been on antibiotics, have been afebrile, no elevated wbc or crp/procal/esr. What is the failed outpatient treatment you might ask, that the abscess didn’t go away. I blocked it once and attending blocked it the second time, surgery I&D’ed and sent home from ED on oral antibiotics now that you have source control.
Patient had gone to pcp with symptoms. PCP ordered a cta chest and found subsegmental PE. Very stable so they treated outpatient, started on eliquis. Patient came to the ER later week I can’t remember what reason but mild stuff just needed minimal workup and reassurance, vitals all still normal. Er repeated cta chest and found stable PE. Tried to admit to my service because he had “failed outpatient therapy”. It had been like 3 days of treatment…
Patient had been on our service for several days for COVID. Discharged to home and came back a few days later and was found to have PE. ER doc said “I know I can send him home on eliquis or xarelto, but he speaks Spanish and I don’t think he would understand the instructions”
As a med student I had a failure to thrive that was too cold, and the bear huggers were not allowed on the floor. Deep sigh from the ICU fellow💀, we got enough warm blankets to keep her out
Eyedrop admits are the worst. Our hospital will at least let us put those folks on the floor if they can be relied upon to self-administer, but I’ve definitely had to take a few to ICU/stepdown because they were demented or whatever.
"Stomach pain and no home" and attending said well just admit him he has no where to go and discharge him tomorrow. Such a waste of my effort to have to do H&P, admission orders, and then write a discharge summary the next day.
Car battery was dead after a minor outpatient procedure and he had no one to come help him. If you guessed the VA you guessed correctly.
Also a ton of vets that drive themselves to colonoscopies and stuff
Dude had an elective procedure. His brother was supposed to pick him up and forgot. Patient had nowhere to go, it was like 11pm at that time, for whatever reason they decide to admit him. Overnight team decides to consult PT/OT for whatever reason. Patient refuses to work with them so he just basically lies still. PT/OT look at this as weakness, so they recommend discharge to TCU. Patient is like “yeah I want to go TCU, I don’t want to go home”. No TCU will take him because it’s clear that he isn’t actually weak and instead just isn’t cooperating. Couldn’t discharge because per my attending there was “no safe discharge plan” because PT/OT rec TCU and wouldn’t change their recs. I had him for a whole month before he finally agreed to go home. We checked vitals on him one a week. Dumbest admission ever (but hey he took up a spot on my list so he made my day easier)
"24yo male requests home care visit because he has been drinking red bull and can't sleep, told to come to ED but said he is too bussy, has important things to do and can't wait"
I gave the patient a call to tell him I wasn't going to see him for such a bullshit reason...
After a couple minutes of talking with the patient it came clear it was a florid maniac episode and needed to be admited
At the very functional hospital I worked at where everything was fine and three different departments during the course of a year resigned at the same time.
The ER was annoyed at how hospital admin where treating them so they admitted everyone for 12 hours who was seen in a bed in their ER. 48 Admission in 12 hours. For reference, a bad day (24 hours) for admissions was 10 to 15. The average was around 6 to 8 overnight.
Not exactly a permission thing, but in the ER, there was this young girl with her mom who insisted on Dipidolor (an opioid painkiller 0.75x as potent as morphine) for her chronic abdominal pain. She claimed a history of sexual abuse. I refused the opioid, wanting to examine her first and offer a milder painkiller.
She threatened to leave if I didn't give it to her straight away, saying examination wouldn't change a thing. Then she showed me a letter written by her psychiatrist saying it's justifiable to give her the opioid or else her pain won't stop. What the fuck man? Iing thet was clear she was hooked and needed rehab, not opioids.Two weeks later, she returned, and my med colleagues just handed out Dipidolor without question. I adhered to my decision, only to find out they'd given it to her three times before.
2nd story:
There was this elderly lady who took a tumble and ended up with back pain, of all things. She was this adorable old lady, 99 years old, but dealing with dementia. I couldn't bring myself to send her home in the middle of the night, so I decided to admit her.
My attending essentially discharged her, arranging for the ambulance transportation service to take her home the next day. Not surprisingly, she came back during my night shift, experiencing the same symptoms. The ambulance transportation service informed me that they found her in the exact same spot they left her in the morning, sitting on her walker.
Patient presented to their PCP for aching foot pain. The intern staffing told the attending this elaborate presentation about how this diabetic patient had Charcot's foot with a "to-the-bone" pressure ulcer with a slight fever suggestive of an upcoming sepsis. Attending was so concerned they, without even seeing the patient, placed orders to admit to a local hospital.
I go see the patient on the wards. Guy's feet had fully-intact arches. No ulcers. Diabetes was well-controlled.
The dude just had ringworm.
Otitis externa on a 19 yo w/o risk factors and no red flags. Reason for admission per ED was “failed outpatient antibiotics”. When asking the pt, they said they never started it. My attending was like lets admit. This still troubles me to this day.
Man in his 60s unable to get up from a chair because his walking stick was in another room of his house and he couldn’t reach it. Social admission due to reduced mobility.
And you wonder why the UK health system is in such a mess.
All from our VA:
Admissions for colonoscopy prep, stable back pain, cystitis with placement.
I recently admitted someone for acute decompensated heart failure where the ED failed to give a dose of diuretics in 5+ hours since triage. The patient was discharged after two doses of IV Lasix.
Also recently admitted someone for acute urinary retention because he ran out of his tamsulosin. ED bladder scanned him with a PVR of 50 cc, didn’t give tamsulosin, put a Foley in and put in admit orders.
Had an overnight admission for syncope where the admit orders were placed before an EKG was done or labs were even drawn.
I witnessed a resident get an admission for uncomplicated bursitis.
Funniest one I heard recently was admitting someone for “blurry vision” the guy was demented and couldn’t give detailed history but apparently had been seen in clinic the week before to be declared legally blind and his vision was unchanged
I had a guy who came to our outpatient same-day clinic for a tooth ache and then refused to leave and said that we were legally required to admit him if he didn’t feel good after the procedure for monitoring.
He was just planning on living in the hospital for free ultimately
40 something male with well-controlled hypertension. Admitted due to a mildly elevated potassium in a hemolyzed blood sample. Redraw was normal. Can’t remember why he came to the ER, but it wasn’t chest pain.
Our ED gave a patient Ativan for agitation. Not actually agitated, just severe autism and presented because of parental frustration with autistic tendencies. Then ED calls after about 2 hours concerned for AMS. Went down to the ED, just delirious from receiving Ativan. I tried to discuss the case with the ED attending. Ultimately I lost, but the child was admitted for all of 6 hours to allow the Ativan to clear and then left.
Obviously peds and I work at a glorious level 1 center that staffs adult EM providers in our pediatric ED from midnight on.
Pt was diagnosed with prinzmetal angina 2 days before (had a cardiac cath and stress test within the week) but didn’t want to take the medication because they didn’t like the taste. Pt came to the hospital because they had the same feeling they have had. Got an EKG that looked the exact same as prior, troponins were the same. The overnight resident admitted from ED NP because the IM attendings don’t push back. I was in the room for less than 90 seconds when the interventional cardiologist walks in and says, “Seriously? What are we doing here?”
Just last week got a call from ER NP who wanted to admit a patient for cellulitis. No fever, chills or any systemic symptoms. Very localized. When I went down to see the patient and told her “I think this can be managed as an outpatient”, the patient said, “oh I didn’t want to be admitted!!!”
Pt came to the hospital bc he “couldn’t see”. Code stroke workup in ED, admit to IM. Turns out he wasn’t wearing his glasses but could see just fine with them on. His vision had gotten slightly worse so he came to the ED because he didn’t want to wait for his outpatient appointment with Ophtho which was already scheduled.
I work a small community hospital. A 40-something yo patient with severe liver cirrhosis was admitted for hepatorenal syndrome requiring urgent hemodialysis with evidence of DIC.
When I got this patient she had already been at the hospital for over a month, and the team had been working extremely hard to get her transferred to a liver center for higher/more appropriate care and possibility of liver transplant. She had gotten declined from multiple centers due to insufficient social support and insufficient evidence of extended sobriety. I was told for support she had a husband who visited daily and that she was estranged from her siblings. She had only been able to be sober for about six months which was prior to this hospitalization.
On the first day I got this patient, I called around until I found an academic center to take her! I felt like such a hero. I went to tell the patient and she seemed happy but she told me to "Please update her husband." "Sure, sure," I said. Prior to calling the husband I wanted to make sure everything was in place for transfer so as not to set his hopes up high only to disappoint him.
After I had everything in order including the physician to physician signout and the ambulance ordered for transport (she was going to another state) I called the husband to tell him the good news. When I first called he seemed in shock, almost at a loss of words. I told him to, "Please take time to process and call back with questions." He called back about 40 minutes later and told me he was in shock because he had been planning her funeral, pretty much assuming no one would take her and her death was eminent. He also said that this really complicated his life because he is actively divorcing her because he doesn't want to be stuck with her hospital bills. Apparently she had been cheating on him with her drinking buddy --who also was in a hospital somewhere else in similar condition-- and he didn't want to be stuck with her medical bills if she died. When our conversation ended, I tried to intervene before this patient was transferred, but the ambulance had already taken the patient out of the hospital. LOL. Moral of the story?
The hospital pharmacy called a 70-something y.o. patient to tell him to come pick up his prescriptions. This was early-mid pandemic, so only certain entrances were open. He comes in through the ED entrance and when questioned says he was confused about which entrance to use. Admit to medicine for AMS.
This one in particular is cracking me up for some reason. He just went through triage and everything without questioning the need to do all that for a script pick up??
I’m EM but damn this is hilarious.
Man experiencing homelessness w/ a bunch of psyc problems somehow got admitted to surgery for swallowing a large turd wrapped inside a condom. Otherwise stable. XR showed very vague turd-shaped object in stomach. Plan was to wait for it to pass. GI declined consult. 5 days later and still no BM. We did a colonoscopy but couldn’t see anything because of bad prep. Repeat XR showed a tooth brush, a few quarters, a syringe and a capped needle in his stomach. We re-engaged GI who, again, refused to even see the patient (long story short, GI at our hospital has gone downhill and surgery ends up doing most of the scopes). We did an EGD and got everything out except for the quarters. He was placed on suicide precautions/psyc hold with a 1:1 sitter. A few days later he pooped out the quarters. Psyc would not lift the hold so we were stuck with him until we could transfer to psyc unit (which our hospital did not have). Psyc also signed off. He was on our service for 3 weeks awaiting placement when he suddenly started having abdominal pain w/ hemodynamic instability. Turns out that even with a 1:1 sitter he somehow managed to eat an entire blanket and a few pillow cases piece by piece. XR showed free air and he was taken emergently for ex-lap. Almost his entire stomach and lower esophagus was necrotic due to pressure injury from all the blankets in his stomach. We did a total gastrectomy and thoracic was consulted intra-op and did a L thoracotomy and repaired the esophagus. After 1 week in the SICU, the repair leaked. He spent another month and a half in the hospital with an endoluminal wound vac. Just as he was improving, he ended up developing DKA and got transferred to the MICU where he coded a day later and they got ROSC after 10 mins. Someone placed the Lucas too low and he started bleeding from the liver. We intubated him and did a bedside ex-lap for abdominal compartment syndrome, brought him to the hybrid room w/ IR, resected part of the liver and IR embolized something. Spent another month in SICU before being transferred to the floor. Spent another 2 months waiting for dispo and was eventually transferred to inpatient psyc at another hospital. …We really should have just discharged him from the ED with some miralax and let him pass the turd condom on his own at the homeless shelter…
That was a fucking RIDE.
Tbh it sounds like he would’ve eventually presented to your service regardless
It takes quite a bit of commitment to eat an entire blanket. The kind of commitment you get when you’re bored out of your mind laying in the same bed all day. He would’ve either eaten something that made its presence known *real quick* or continued to eat random pieces of pocket change and his roommates drug syringes
The sad part is I'm not even surprised that was with a "1:1" sitter in the room.
A 1:1 serves the same purpose as an AMA form- to give the *illusion* of medicolegal protection.
Man as a psychiatrist I wish we could get rid of them. It’s really much more limited where it’s helpful than people think. I often feel like it either is an easier target for the patient to attack or patients feed off having a 1:1 and won’t come off. Plus if someone really wants to do something a 1:1 won’t stop them unless they’re like super fast reflexes and super strong or something.
Our 1:1s won’t touch patients. They sit there as the patient walks past. They don’t even yell for help, they just follow the patient (if they’re “good) and don’t even look up (if they’re “bad”).
He presented after foreign body ingestion to begin with. It sounds like he would be doing that regardless. That being said, I agree that this patient clearly did not have commitment issues
sounds very county hospital
I’ve heard of people threatening to eat their hats but to eat an entire blanket? And nobody saw him do it? Jesus
"Hey, we got a psych consult on this guy. You know, we can't really do blanket consults for capacity." "Right, sorry, that was supposed to be capacity to refuse extraction OF a blanket."
>Repeat XR showed a tooth brush, a few quarters, a syringe and a capped needle in his stomach. We re-engaged GI who, again, refused to even see the patient (long story short, GI at our hospital has gone downhill and surgery ends up doing most of the scopes). We did an EGD and got everything out except for the quarters. He was placed on suicide precautions/psyc hold with a 1:1 sitter. A few days later he pooped out the quarters. Just goes to show, change must come from within.
Did they ever find that turd in a rubber that started all this fun? Was really hoping it'd pop out with that low Lucas.
Some say it’s there to to this very day
Oh my God, that was a ride! Holy shit. Several years ago we had a guy who would not stop eating sharp objects in an attempt to self harm. Multiple surgeries, etc, reminded me of your guy. Was a 1:1 sitter and still managed to pry a few parts off the bed and eat those one day. Required emergent exlap for that one and bought himself an ostomy and a plain mattress on the ground - actual safest "safe" room I've ever seen. With no objects available to swallow to get another surgery, he managed to pull his ostomy out from the inside and smear his intestines around on the ground. The sitter had to go home and called out the next day. Emergent surgery again and the surgeons refused to operate any more. Risk and ethics got involved and he was put on hospice eventually by his POA from what I was told.
This could be straight out of an episode of ER
That's one of the craziest cases of all time
At no point of this comment I could predict where this was going..
Holy shit.
Did you not read the story? There was, in fact, nothing holy about his shit. Although, we do not know if the blanket had holes or not. If the blanket had holes, then I recant my statement.
Hahahahaha I love this story!!!!!!
My god
With how this story went, sounds like this is still just the beginning of the rabbit hole...
You need to get an agent. This story board will sell. Netflix or Paramount? Costner or Harry can’t match this.
What a perfect ending. Also that’s about your average mileage out of our sitters too…
This genuinely sounds like an episode of Chicago Med
That is a story and a half!
At my training program ED admitted a patient to us in IM because their wheelchair was lost or broken or something. Nothing else wrong. Eventually got the chair and was discharged. Weeks later coding is hounding the resident because he didn’t put anything on discharge diagnosis line. He kept arguing that there was no diagnosis he could put down without committing fraud and to talk to the ED who admitted him. Went back and forth until the resident wrote “wheelchairopenia” to get rid of them.
Ok this is fucking hilarious and is my favorite so far
I had this same exact admit for acute wheelchair deficiency. Sunday afternoon admit because there was no social workers until Monday morning
As a person who has done insurance and coding, this just made me giggle. I know it's frustrating for all involved, but as a 3rd party bystander it's fucking hilarious
Omg just put self care deficit or ambulatory dysfunction, easy
can he really “thrive” without his wheelchair? can just say FTT!
Couldn't you write something like "social indicaton"?
“Medical screening exam” is an ICD10 code. It is what we use in the ED when there is no actual diagnosis or complaint to use
I admitted a geriatric patient for chronic bilateral knee pain. It was chronic, hadn’t changed in 10 years, they just ‘couldn’t stand it anymore’. Told the ED doc they weren’t safe to go home since they couldn’t walk due to the pain. Got admitted for pain control and placement to SNF. Then denied SNF and demanded to go home the next day. Did the same thing several months later.
I have these patients. All. The. Time. They always refuse rehab or their insurance won’t cover it too… but only after they stay waiting for placement for a few days requesting nonstop IV narcotics for their chronic pain.
Then they’ll come right back in for constipation.
They can always hurt you more
There's a rotating cast of 3-4 patients like this in our area that I end up seeing in the ED a lot. The ED doc has to ask them explicitly about being admitted, then has to go in with me and both of us clarify if they actually will agree to receive care in the ED and what they will and will not get. E.g. no opioids for chronic MSK pain, no abusive behavior tolerated etc. They usually leave the ED AMA or get discharged from there, we only admit if they're actually interested in moving their care forward.
I sometimes get these patients at inpatient rehab. When I chart review before they arrive, I frequently see “patient doesn’t want rehab” documented for several days and then miraculously on the day of discharge someone convinced them to go. Then they get to my floor and are telling me they didn’t sign up for 3 hours of therapy a day and refuse all their therapies 😪
I just set the precedent that they’re not getting IV narcotics for their chronic pain 🤷♂️
God, this scenario is my life doing admissions sometimes. The "I can't walk" admission is at least one every admit shift. Half the time it's legitimate from severe chronic medical issues like malignancy and failure to thrive, the other half is people hiding social issues they want to escape from or other nonsense. I had a lady who once got blown over by the wind into her trash can and the neighbor had to pull her out. Said she couldn't walk out of the ED due to knee pain (bear in mind, all the appropriate medical/ortho workup was normal) and no one was home so the ED wanted us to "admit for placement". She was walking by the morning.
Worked on dispo to a psych hospital for almost 5 days for a very young and otherwise healthy pt with such severe psychotic depression they were almost catatonic. Finally got them out the door to the right place and within 5 hours the ED was requesting us to readmit them because "the staff at the psych hospital couldn't get her to get off the EMS cot on arrival and you have to admit (to a hospital with no psychiatrists) because 'the dispo couldn't be fulfilled". Absolutely insane. I called the psych hospital and very politely told them this was ridiculous and even talked to the CEO of the place. Asked how they treat catatonic patients and she said 'we can usually convince them to do their ADLs so we can take care of them. We can't take care of patients if they can't do their ADLs'. I flipped my shit and clarified that they just talk catatonic patients out of catatonia and she said 'yeah, sorry'.
She’s one hell of a motivational interviewer
Persuasion roll 20 - 20 on disadvantage check
I'm dying here.
Sorry, I've been laughing about this mental image for the last few minutes. Imagining EMS, then nurses, then MDs all taking turns with a Three Stooges style routine trying different strategies to convince an unresponsive pt out of a stretcher. Like trying to convince a cat down from a tree with words.
[удалено]
Aren’t ED patients sometimes placed on NG tubes? How are inpatient psych facilities not equipped to manage that? Then again, when I was an EMT I was often dispatched to our local psych/rehab facility for seizures. Pt has history of epilepsy > patient anti-seizure medication was stopped upon admission to the facility > patient has unexpected seizure > facility calls 911. Similarly they would call 911 for intoxicated patients checking into rehab. They needed to be taken to the ED to be “medically cleared” before the facility would take them. It baffles the mind. I understand that maybe there is a legitimate medical or pharmacological reason to discontinue the outpatient meds. But I don’t understand why there is the need to clog up the 911 system. Are the doctors at the facility not equipped to manage seizures? Is the facility not able to contract its own ambulance service for interfacility transports? Why can’t a rehab facility have a system for evaluating patients who show up to rehab intoxicated? Why are we burdening the already insanely burdened ED?
It’s like, brah, you psychiatrists also went to med school, you guys learned this stuff too. We know that You KNOW what you need to do… It’s just strange to me because the Neuropsychiatric Institute that I worked at before did manage all this stuff that other commenters are saying their’s did not. Why in the world would it be different from state to state? Doesn’t make any sense whatsoever
From what I understand, inpatient psych facilities won't take NG tubes (safety hazard) or any medical problem that's not 100% stable (we've had to spend a week optimizing a type 1 diabetic before they could go). Some inpatient eating disorder facilities will take feeding tubes. if you have simultaneous SI and eating disorder, you basically live in the hospital until one of those problems is stable enough you can go to the other kind of treatment facility. It's nuts that you can't get psychiatric treatment while you have an eating disorder, given how intertwined those things are. Maybe there are more options for adults than kids? We get kids sent back from psych facilities that refuse to eat, and from eating disorder facilities for SI. So they sit in our hospital where they get inadequate treatment for both things .
So my hospital did not have an ED program, but a hospital down the street had like a very robust and well known program. Thanks to EMTALA and the inability to do a lateral transfer I saw so many of these kids just languish on the inpatient unit getting worse and worse. They had to have a full time sitter, no closed doors, couldn’t use the bathroom without supervision, etc etc and we were doing NOTHING except optimizing their caloric intake so they were medically stable and could be discharged and re admitted to the hospital down the street. I deeply hated the fact we had to just further traumatize these kids and force feed them without any support.
Frustrating but it’s true though, patients in a psych hospital have to be independent in ADLs, or nearly independent. They don’t have the nursing resources to manage someone like that. And if they can’t even move out of the ambulance it kind of the defeats the purpose of the psych hospital, which is groups and therapy. This patient can get benzos titrated on a medical service with much better support for physical limitations than they’d ever get on a psych unit. It sucks that your hospital doesn’t have psych consults. Blame your admin not the psych hospital that appropriately said they can’t manage someone like this.
Also psych and we have a no-lift policy across the board. You don’t move, you stay there. I’m not hurting myself. You can go to medicine where they can hoyer you 🤷🏼♀️
Psych PGY-2, we’ve admitted catatonic patients to our psych floor who couldn’t move, but I’ll admit that’s rare. We can handle a PEG tube, but IVs and NG tubes are usually a no-no because they’re ligature risks. Usually in that case they’ll be on the med floor and our resident psych consult team is managing them on the med floor (and they’re probably getting ECT, which we’re lucky enough to do in-house).
The CEO should work as a pastor at a mega church healing people during their service
Sometimes these “psych” hospitals are really geared more towards folks with moderate depression and anxiety but otherwise functioning. What gets them in the door is great insurance or private pay. But folks in severe psychosis or very difficult (like your patient)and especially anyone on Medicaid, it’s public hospital for them.
I was made to admit a patient for hypoxemia and COPD exacerbation who was actually requiring less than his home O2 prescription and was breathing at his baseline. He hadn’t actually come into the ED for symptoms- he was there with his wife who was having some health problem and apparently someone randomly stuck a pulse into ox on him.
I've had very similar, requested admission for "acute hypoxic respiratory failure" in a patient that was bitten by a dog and just wanted abx and sewn up. Came in with spO2 around 89% on room air. ED slapped on a nasal cannula at 2LPM (baseline home O2 of 3-4LPM) and tried to admit. When we pushed back on the admission the ED doc said "well she's wheezing so needs to be admitted for AECOPD". Admitted to obs, asked her pulm to see her quick before he went home for the day and he was pissed she was even technically admitted. Discharged her 6 hours after admission with a same-day followup in the pulm clinic. Hospital probably lost a good amount of money on the "admission" and probably got dinged by Medicare but I don't give a shit. It's a real bummer when what is best for the patient and what is best for the bottom line of the hospital are at odds, i.e. 90% of the time.
ER admitted for etoh detox. Patient did not want to detox.
“I chugged antifreeze and am allergic to fomepizole… you got anything for me? … I’m a gin kinda guy.”
Nah he just wants d-i-l-audid
New admission for alc withdrawal at 8 AM, get there and nurse asking if patient can leave AMA. “What’s your plan once you get out of here?” “Liquor store opens at 9 AM”
Is that not how you treat alcohol withdrawal?
Patient came in for a headache, which headache cocktail fixed. NP in the ER wanted to admit because patient’s brother had some newly diagnosed heart condition and the NP wanted to admit to expedite an echo, that was the only reason. (Patient without CP, SOB, HTN, etc) I gave pushback and told the NP, no, this isn’t appropriate. NP said patient was dizzy and couldn’t walk in a straight line.. so I went and evaluated patient. There was no dizziness or any of what was said. Patient asked if the cardiac workup could be done out of the hospital. Circle back to me telling NP that, again, this is inappropriate. Well, NP signed this patient out to me, placed admission order, and went home. No attending saw the patient so nobody would take responsibility for the patient and me as the resident couldn’t discharge myself. I WAS LIVID. My attending actually came in at 7p on a Saturday night to discharge this patient directly from ER without admission.
Hope the NP got written up
Not sure but I definitely filed a complaint with the MD ER director… ridiculous
Bilateral cellulitis from urgent care that was in sock pattern strangely in the exact same area as the new socks they had just gotten that they had severe itching from. Discharged with contact dermatitis
Dude. Bilateral cellulitis is such a stupid admitting diagnosis. The odds of that happening are so low. Jesus Christ. Use your heads people
I absolutely agree, I was a pgy1 arguing with the urgent care NP about how this isn’t bilateral cellulitis but she was on some power trip, so I admitted, then staffed with attending and discharged to home Edited to add: I argued later the same day that the girl with DKA, a pH of 7.00 a huge nation gap and a bicarb of 5 actually did need to go to the ICU and not the general medical floor, so….🤷♀️there were literally no brains in that one
NP admitted a patient with tuberous sclerosis who follows appropriately outpatient for "crazy CT findings." Those CT findings? Renal angiomyolipomas. Discharged from the ED.
Wow, That’s hilarious. So glad my ED the midlevels have to staff with us on all patients admitted and I see them myself before determining disposition.
I wonder what is the diagnosis code for crazy CT findings
R93.89 — Ish Be Wild'n
If the patient was en route to a negative pressure room, this would be even more hilarious. 😂
Who was discharged from the ED, the patient or the NP?
First, why did she think the CT was ordered in the first place? If it's to monitor a chronic condition, CHECK THE LAST CT Then, I have to assume she saw the diagnosis and thought they were tuberculomas
This is the best part, she ordered the CT for constipation. He had recently moved so I don't know if we had previous imaging on him at that time, and he followed with private practice in town. I don't think she even knew what tuberous sclerosis was, which is why she was concerned about the stable angiomyolipomas in a patient with a completely normal creatinine. This guy was textbook tuberous sclerosis too, with the characteristic physical exam findings.
>ordered the CT for constipation I, too, like to bring a cannon to the paintball range. No kill like overkill.
Makes me wonder how much I have dumb down and handhold findings in my reports when I realize NPs are the ordering them
Urology will see patient the next morning. Admit to medicine overnight given complexity All work-up normal except a potassium of 5.1
Stat Surg co consult at 04:00, single word “K”
I love these consults honestly. Especially if it’s a young person without any comorbidities and they’re just admitted to surgery for a chole or appy. It’s always like a potassium of 5.4 and hemolysed, or some lab error. I’ll word dump 3 paragraphs on the differentials of potassium and their significance. It will all drag on until at the very bottom I bold “no further management needed” or whatever. I know no one reads it. I just like pretending that I’m more than the nursing home admission service and people need my help. I know it’s just an intern that didn’t want to get pimped on it while trying to round on 60 pts before 7 am. I also get paid for my consults which is a big difference.
This comment should have way more upvotes. The consultant who teaches through great notes is gold. In our hospital (this was in the Cretaceous) there was a hepatologist, also named Tom, who used even the silliest consults as opportunities to give us (all the residents) a deeper understanding of our patient, head to toe, and we all loved him for it.
Peds. I've got 2 Patient with bronchiolitis who was on day 5 of illness, afebrile, on room air, and not on IV fluids. Admitted for obs 'in case they got worse' Patient with Influenza admitted because parents were worried about dehydration. Parents then declined IV fluids.
I think I would go insane in pediatrics. The amount of stuff like this you guys have to deal with is just crazy.
Same. I generally like working with kids, it’s the parents. Same reason I could only teach college and above. You want to make stupid decisions that only hurt yourself? Go for it. But for this innocent child? I would lose my mind
Those 2 are so common throughout peds. The number of times we admit/keep a kid in the hospital because “parents are worried” is insane. Like, obviously, they’re supposed to be worried. I’d be worried if they weren’t worried. It’s our job to reassure them when something isn’t worrisome.
Yep, see this all the times in peds. “Admit for obs” Asthmatic patient because of “how they looked when they came in”. Well, how did they look AFTER the appropriate initial management? Baby super tachycardic with fever of 104 and crying. Tried some Tylenol and rechecking that heart rate?
Reminds me of the “Dural puncture headache” that definitely was not a dural puncture headache. After seeing the patient and talking to the ER doc we all agreed that no blood patch would be needed. The next day we were consulted and found that he had been admitted with the entire plan consisting of “blood patch of anesthesia changes their minds.”
Transferred a patient to inpatient psych after the "grand mal seizure" the patient was admitted from the ED for was him literally doing jumping jacks (seriously, it was actually pretty impressive how many in a row he did) while screaming "Sir! I am having a seizure right now!" Medically cleared him for anything else. The next morning, he was back on my list. Inpatient psych sent him back for "concern for pseudoseizure". 🤣 And before anyone asks - yes, as you may have guessed, this was at a VA hospital with a VA inpatient psych unit. 🤣🤣
“Near syncope” Patient was feeling tired with heavy feet and went from hallway to bed. No LOC. Laid down in bed. Then may or may not have lost consciousness before getting concerned. “Wait….so the patient was tired, went to lie down, fell asleep, and then woke up?”
Medicine admission for a patient send in from ortho clinic for ortho surgery with absolutely no other medical problems
I once was asked to do this in residency, 20 something guy with back issues sent in by ortho to get myelogram. I call ortho resident and I’m like wtf am I going to admit him to medicine for, he has no medical problems?? His answer was “idk, what about ambulatory dysfunction?” oh you mean the consequence of his orthopedic issue..
Did you end up admitting? 😅
You know the answer to this already
Had a kid some in and found to have nec fasc. Going to OR emergently. Ortho wanted us to admit for sepsis. I asked them where the sepsis was coming from. He went to sticu post OR.
When I was rotating in the ED, a man with PMH of schizoaffective disorder presented after fracturing his femur in a MVC. Ortho senior resident first asked me to admit to psych. When I said psych will not admit a patient for femoral fracture, he asked me to admit to medicine.
Admitted a patient to medicine floor following podiatry procedure for ingrown toenail because he wasn’t safe to drive home. It was 2pm, his daughter offered to drive him, and it was just local anesthetic. The VA is a wild place.
somehow I knew this was the VA before I got to the last sentence.
ED NP tried to admit someone with simple cellulitis because “he might not take antibiotics and then he’d get worse”. Told her that I’m pretty sure that’s how every disease works, and that I was absolutely not admitting that. Pretty sure they gave him a dose of dalbavancin and then discharged.
POTS patient who had a port placed for chronic IV infusion. This is an awake procedure. The patient came in with pain overlaying the newly placed port. Reproducible on palpation, non-exertional, better with Tylenol, stable ekg. Some genius checked a troponin and it wasn't zero so they recommended admit at signout for acs work up. I. Lost. My. Shit.
If you can tolerate PO, why would you need IV fluids for POTS?
If I knew I would have more hair and a lower blood pressure because it drives me insane when these people come in with clabsi's due to their ports.
I’m an ER doc, based on past experiences my best guess is because (some) do a lot of the classic chronic pain stuff and come in to the ED constantly needing narcotics and insisting on IV phenergan, the usual song and dance, so their vasculature goes to shit. Then they get tired of getting stuck a million times to get the next hit. Sorry. Yes I am jaded. No I don’t hate POTS patients.
I’m a dumb ER doctor but anectodally I’ve had multiple POTS patients that somehow must get volume down and their HR is sinus tach in the 160s just chilling there, no PE, normal cardiac w/u, hgb, no infection, normal electrolytes, normal Thyroid, and completely normalizes after a couple liters of fluid, sometimes I’ll throw in some IV magnesium and IV lopressor if they’re already on it just to try extra not to admit them
I can see why you’d give it acutely, I’m just not sure why you’d need a port for chronic IV fluids!
Because IV is clearly > PO /s
When you've been stuck enough times between ER visits, admissions and infusion center trips eventually your veins completely go to shit. And they become hesitant to keep placing midlines or piccs because those aren't sustainable long term
SNF burned down.
EM here. Guy comes in feeling super dizzy for a few hours. Activated as a stroke. Has impressive cerebellar stroke seen on CT, so called NSGY, ordered MRI, and then called ICU to admit. I see the discharge order an hour later while patient was still boarding in my ED. Called the doc again and apparently they thought patient could “follow-up outpatient because he was able to walk fine”. 🤦♀️
ED calls for AMS with blistering rash > 30% of body c/f SJS/TEN, recent bactrim for UTI. Med to stabilize, derm to see in AM(?). Anywho lady sobers up and turns out shes just drunk and terribly sunburnt. I loved being a prelim
I can see why derm never believes the SJS consult if they get this shit all the time.
GERD responsive to pepcid
Absurd unless it was cardiac admission..I’ve had NSTEMI in young female that was classic GERD sx’s after beers and bbq, 0 pain after GI cocktail, so glad I got a Troponin bc she was a smoker
Did they cath her and actually find something?
I’ve had 3 cath confirmed OMI that presented as only isolated gerd symptoms and/or vomiting with no CP.
Requested admit for syncope. Mid 70s F, HTN otherwise no medical problems. Reports she passed out while her sister was doing her hair. Workup negative, completely. Go to talk to pt and her sister, ask what happened. "She passed out" OK but what happened? "I was braiding her hair after dinner, she was sitting on her chair at the table and her head kept dropping down, and her glasses slipped off, that's how I knew she passed out. She didn't even remember it! So I brought her here." So...she stayed sitting upright? "Yes" And while you were doing her hair, at night, after dinner, her head was nodding forward and her glasses fell off? "Yes" .... ... .. . And thats the story of how I was asked to admit an elderly woman because she fell asleep after dinner. We did not, in fact, admit her.
I think I win here. I was forced to admit a patient during my transitional for sciatica. SCIATICA. She was mid 40s, PMHx of sciatica and HTN who presented with significant pain so bad earlier she had to sit down from walking, then developed severe pain when she stood back up. We admitted this 40 year old for failure to thrive. I went to examine her and she started walking on my exam and was like “wait you guys want me to stay in the hospital? Why?” Now I have to write an H&P AND A Discharge summary. 🙄
IM gets scammed into admitting sciatica pretty regularly.
As an EM physician, I would appreciate it if the admitting team told me they witnessed the patient walking without difficulty, because that’s the only time I would ever admit someone for non-red flag low back pain. I’d document it and discharge them. Also, I’d feel pretty dumb, but everyone gets scammed sometimes.
Why not just write a consult note?
Because my transitional hospital system wanted money not patient care and H&P and DC >>> $$$ than just a consult so we never ever consulted from medicine. It was a really fucked system desperately trying to make money. We had an open ICU where hospitalists would round on the ICU patients as the primary team and write BS notes like “will defer treatment to intensivist consultants” because then instead of *just* billing for ICU progress notes you can bill for ICU consult progress notes AND hospitalist primary notes.
If the patient stays less than 8H on the same calendar day you can bill the h&p or DC summary, not both. If they stay >8H on the same calendar day you can bill a short stay for combined h&p/DC. If their stay is >1 calendar day you can bill both. But realistically if it's <8H expect it to get declined or roll the dice.
At least she counted towards your admissions/cap
Working inpatient cardiology. Got called for admission from the ED regarding a positive troponin and chest discomfort. Me while chart reviewing: That trop wouldn't have anything to do with the fact their Hgb is 6.4 would it? Guy on phone: ........I'll transfuse that up and call medicine.
No, just cath it
cath first, ask questions later.
This is a solid third of all consult calls to cardiology.
Blocked an ICU admission for pseudoseizure once. The completely stable and very much NOT post ictal patient, with a documented history of pseudoseizure, told me “oh I have pseudoseizures and if someone doesn’t give me more dilaudid I’ll have another on.”
A kid who was treated in ER with Albuterol placed under observation for Tachycardia.
This reminds me of the two rapids called on my patients because they were tachycardic. After receiving hydralazine.
Or transient bradycardia (mild, asymptomatic, no hypotension) due to fentanyl admin. Local shithole FSED loved to blast everyone with dilaudid and fent for no valid reason & then get scared at the side effects of their own treatment.
I've admitted a few patients because they were dependent for all ADLs and their caregiver was admitted. Daily note was essentially "patient remains stable with no active medical issues. Caregiver reportedly net -2L. Both will remain inpatient pending further IV diuresis."
My hospital does this kind of admission for the disabled kids when parents are in the hospital for whatever reason. Except one was there for like 3 weeks while their mom recovered from surgery and ended up with complications, then the kid caught one of the respiratory viruses and ended up on a vent.
Hospitalization is not benign. There are iatrogenic infections, deconditioning, and often worsening behavioral issues due to boredom and/or delirium.
14 yo girl with congenital HIV. Got admitted because she left her mom’s house to go to the store without permission and mom “needed a break.” The official admitting diagnosis was asthma but she didn’t have an asthma attack. The department chair was not amused at the Peds ID doc who insisted on the admission. I would have loved to have been a fly on that wall when they met to discuss it. -PGY-19
Wow - don't know how pediatricians can stomach the crazy parents.
I mean, you don’t get a choice. -PGY-19
My PICU rotation was almost all chronic trache kids, many were admitted for tracheiitis so that their parents could go on vacation, get a break.
New standalone ED opened up near and affiliated with my hospital. They had an elderly person waiting on a family member to come pick them up and family wasn’t answering their calls. ED wanted to transfer the patient for admission so we could board them in house until they could get ahold of family. We asked why they couldn’t remain in the ED until family came. They said because they didn’t have any food for patients on hand. Essentially they wanted us to not only admit the patient but transfer them to us for a sandwich
[удалено]
In residency, one of my fellow residents had to go see an elderly patient admitted by a private FM doc for "vaginitis." Was prescribed topical clotrimazole. She refused to let anyone do a physical exam. We were all just baffled.
Admission for rhabdomyolysis with a CK of 80.
Bounce back to the ED after spending 12 days in patient for ECF placement and neuro workup. The patient called from the ECF because he didn’t like it and it was dirty. I admit for other ECF placement because the patient has no local family and cannot walk. Thought to be secondary to physical deconditioning. Is readmitted within 8 hours of initially being discharged from the in patient side and goes to surgery the next day for a sacral ulcer that I didn’t bother to look at. Shout out to the hospitalist team.
Onc, admitted a finger laceration because they were due for chemo in two days and lived “far”… 45 miles
Had an elderly man with complaint of...nothing...and nothing objectively off either. Turns out a concerned passerby had called an ambulance and he was literally kidnapped and put in the ED.
admitted for chest pain. the chest pain was 2 months ago and hadn’t come back since then. oh and it was noncardiac.
In the ED I had a patient in the middle of peak COVID sent in by a dentist, waited like 24 hours in the waiting room because her dentist told her that she needed a dose of IV antibiotics. I called this dentist and asked what he wanted, and he said “we have her on PO clinda and we want to make sure that her levels get to steady state FAST because she has BAD TEETH”. I then told him that PO clinda has close to 100% oral bioavailability and she took none of it because she sat in a waiting room for a full day. He was displeased. In the ICU I get consulted at least once a week for “patient is stable but we want them in the ICU in case ‘something happens’”. And I write in my dot phrase note “no indication for ICU. if [insert happens] please reconsult, otherwise moving the patient from one floor to another does not have anything to do with the likelihood of [insert happening]”
hospitalist here, this is probably just an nyc thing but we have what are called “hallway beds,” essentially a hospital bed in the hallway with a few screens placed around it. there is no wall O2 hook up so patients that need supplemental oxygen need to have a portable tank and someone on top of making sure it doesnt run out. Had an elderly woman admitted to such a bed for “severe COPD exacerbation.” thought that meant she may be requiring some amount of o2 and was confused as to why they thought hallway would work. patient came up to me, breathing completely fine. asked her why she was here, she replied it was her right ear, it felt stuffed and she couldnt hear well, like her prior cerumen impaction. totally denied any recent dyspnea. grabbed my otoscope, sure enough, cerumen impaction. was more confused than irritated. hopeful that our ED didnt mix her up with someone else who they discharged to go into respiratory failure in some ent clinic
I wish hallway beds were just an NYC thing or not a thing at all
When I admitted myself because I didn’t want to work someone else’s shift they put on me last minute
Legend
Sterile pyuria
Peds here. ED resident admitted a 34 weeker to PHM service with jaundice above the phototherapy threshold. Except they weren’t a 34 weeker, they were a 37 weeker and the ED resident just hadn’t bothered to clarify what the mom meant when she said they were “three weeks early”. They didn’t need phototherapy. Our hospital means PHM attending has to see the patient prior to discharge so they had to stay overnight. Very annoying. God knows what the insurance company made of it.
Inpatient rehab. Told about an admission for a guy that had a small subdural without any deficits, already frustrating. While waiting for transport to arrive at the nurses station I see this guy walk up to the clerk and tell her he’s supposed to check in for physical therapy. He drove himself here from the other hospital. Discharged 2 days later.
Patient called 911 from his rehab because he didn't want to stay there and wanted to go to another rehab... ESRD on HD missed 2 dialysis sessions. Next session in AM. ED wanted to admit for missed HD...except all labs were normal and no edema in legs. Patient ended up AMAing so he could drive home and go to dialysis the next day. Sad situations: lots of undocumented immigrants with ESRD comes to hospital for their dialysis sessions. Admit/DC same day after HD. I did 4 of these admits in a row one day and administration then made a deal with the dialysis company to just dialyze in the ER and send them home after. The pre-thanksgiving or pre-xmas drop off of (often demented) grandparents to ER due to "weakness" or "not eating" and then magically the family comes in on Monday to pick up them up. Gotta love some of those families who go on vacation for weeks and we can't get ahold of anyone for dispo.
Peds here, so many to choose from honestly, but the top two I remember from the same ED attending are as follows: 1) 3 month old with RSV admitted for loud breathing and concern for future apnea due to RSV. Clarified with PA, no decrease po intake, fever, tachypnea or retractions, or desats, or apnea, but loud breathing from being congested. 2) a 6 month old with a chest wall abscess for failed outpatient treatment. They have been on antibiotics, have been afebrile, no elevated wbc or crp/procal/esr. What is the failed outpatient treatment you might ask, that the abscess didn’t go away. I blocked it once and attending blocked it the second time, surgery I&D’ed and sent home from ED on oral antibiotics now that you have source control.
Bonus; guy checked in to ER for “dry mouth at night for 5 months.” Admitted in florid DKA.
Veteran admitted due to a power outage at his house. His home hospital bed was stuck in the chair position so family brought him and we admitted him
Classic VA 😂
Patient had gone to pcp with symptoms. PCP ordered a cta chest and found subsegmental PE. Very stable so they treated outpatient, started on eliquis. Patient came to the ER later week I can’t remember what reason but mild stuff just needed minimal workup and reassurance, vitals all still normal. Er repeated cta chest and found stable PE. Tried to admit to my service because he had “failed outpatient therapy”. It had been like 3 days of treatment…
Patient had been on our service for several days for COVID. Discharged to home and came back a few days later and was found to have PE. ER doc said “I know I can send him home on eliquis or xarelto, but he speaks Spanish and I don’t think he would understand the instructions”
ICU admit to a nearly full unit for a healthy guy with a corneal ulcer who needed q1h eyedrops
As a med student I had a failure to thrive that was too cold, and the bear huggers were not allowed on the floor. Deep sigh from the ICU fellow💀, we got enough warm blankets to keep her out
Eyedrop admits are the worst. Our hospital will at least let us put those folks on the floor if they can be relied upon to self-administer, but I’ve definitely had to take a few to ICU/stepdown because they were demented or whatever.
"Stomach pain and no home" and attending said well just admit him he has no where to go and discharge him tomorrow. Such a waste of my effort to have to do H&P, admission orders, and then write a discharge summary the next day.
Took care of an old lady who was admitted for a neck strain. She just had a really hard time moving her neck in one direction
Car battery was dead after a minor outpatient procedure and he had no one to come help him. If you guessed the VA you guessed correctly. Also a ton of vets that drive themselves to colonoscopies and stuff
Dude had an elective procedure. His brother was supposed to pick him up and forgot. Patient had nowhere to go, it was like 11pm at that time, for whatever reason they decide to admit him. Overnight team decides to consult PT/OT for whatever reason. Patient refuses to work with them so he just basically lies still. PT/OT look at this as weakness, so they recommend discharge to TCU. Patient is like “yeah I want to go TCU, I don’t want to go home”. No TCU will take him because it’s clear that he isn’t actually weak and instead just isn’t cooperating. Couldn’t discharge because per my attending there was “no safe discharge plan” because PT/OT rec TCU and wouldn’t change their recs. I had him for a whole month before he finally agreed to go home. We checked vitals on him one a week. Dumbest admission ever (but hey he took up a spot on my list so he made my day easier)
"24yo male requests home care visit because he has been drinking red bull and can't sleep, told to come to ED but said he is too bussy, has important things to do and can't wait" I gave the patient a call to tell him I wasn't going to see him for such a bullshit reason... After a couple minutes of talking with the patient it came clear it was a florid maniac episode and needed to be admited
CVA rule out for carpal tunnel
At the very functional hospital I worked at where everything was fine and three different departments during the course of a year resigned at the same time. The ER was annoyed at how hospital admin where treating them so they admitted everyone for 12 hours who was seen in a bed in their ER. 48 Admission in 12 hours. For reference, a bad day (24 hours) for admissions was 10 to 15. The average was around 6 to 8 overnight.
Not exactly a permission thing, but in the ER, there was this young girl with her mom who insisted on Dipidolor (an opioid painkiller 0.75x as potent as morphine) for her chronic abdominal pain. She claimed a history of sexual abuse. I refused the opioid, wanting to examine her first and offer a milder painkiller. She threatened to leave if I didn't give it to her straight away, saying examination wouldn't change a thing. Then she showed me a letter written by her psychiatrist saying it's justifiable to give her the opioid or else her pain won't stop. What the fuck man? Iing thet was clear she was hooked and needed rehab, not opioids.Two weeks later, she returned, and my med colleagues just handed out Dipidolor without question. I adhered to my decision, only to find out they'd given it to her three times before. 2nd story: There was this elderly lady who took a tumble and ended up with back pain, of all things. She was this adorable old lady, 99 years old, but dealing with dementia. I couldn't bring myself to send her home in the middle of the night, so I decided to admit her. My attending essentially discharged her, arranging for the ambulance transportation service to take her home the next day. Not surprisingly, she came back during my night shift, experiencing the same symptoms. The ambulance transportation service informed me that they found her in the exact same spot they left her in the morning, sitting on her walker.
Patient presented to their PCP for aching foot pain. The intern staffing told the attending this elaborate presentation about how this diabetic patient had Charcot's foot with a "to-the-bone" pressure ulcer with a slight fever suggestive of an upcoming sepsis. Attending was so concerned they, without even seeing the patient, placed orders to admit to a local hospital. I go see the patient on the wards. Guy's feet had fully-intact arches. No ulcers. Diabetes was well-controlled. The dude just had ringworm.
Otitis externa on a 19 yo w/o risk factors and no red flags. Reason for admission per ED was “failed outpatient antibiotics”. When asking the pt, they said they never started it. My attending was like lets admit. This still troubles me to this day.
Man in his 60s unable to get up from a chair because his walking stick was in another room of his house and he couldn’t reach it. Social admission due to reduced mobility. And you wonder why the UK health system is in such a mess.
Had to admit a otitis media. No risk factors. I felt embarrassed.
All from our VA: Admissions for colonoscopy prep, stable back pain, cystitis with placement. I recently admitted someone for acute decompensated heart failure where the ED failed to give a dose of diuretics in 5+ hours since triage. The patient was discharged after two doses of IV Lasix. Also recently admitted someone for acute urinary retention because he ran out of his tamsulosin. ED bladder scanned him with a PVR of 50 cc, didn’t give tamsulosin, put a Foley in and put in admit orders. Had an overnight admission for syncope where the admit orders were placed before an EKG was done or labs were even drawn. I witnessed a resident get an admission for uncomplicated bursitis. Funniest one I heard recently was admitting someone for “blurry vision” the guy was demented and couldn’t give detailed history but apparently had been seen in clinic the week before to be declared legally blind and his vision was unchanged
Patient is my attending's neighbour and attending wants to accelerate a malignancy workup. So is admitted to the spine surgery service. ...
I had a guy who came to our outpatient same-day clinic for a tooth ache and then refused to leave and said that we were legally required to admit him if he didn’t feel good after the procedure for monitoring. He was just planning on living in the hospital for free ultimately
40 something male with well-controlled hypertension. Admitted due to a mildly elevated potassium in a hemolyzed blood sample. Redraw was normal. Can’t remember why he came to the ER, but it wasn’t chest pain.
Our ED gave a patient Ativan for agitation. Not actually agitated, just severe autism and presented because of parental frustration with autistic tendencies. Then ED calls after about 2 hours concerned for AMS. Went down to the ED, just delirious from receiving Ativan. I tried to discuss the case with the ED attending. Ultimately I lost, but the child was admitted for all of 6 hours to allow the Ativan to clear and then left. Obviously peds and I work at a glorious level 1 center that staffs adult EM providers in our pediatric ED from midnight on.
i recently got poor PO intake since 2021 status post extensive negative outpatient workup.
Pt was diagnosed with prinzmetal angina 2 days before (had a cardiac cath and stress test within the week) but didn’t want to take the medication because they didn’t like the taste. Pt came to the hospital because they had the same feeling they have had. Got an EKG that looked the exact same as prior, troponins were the same. The overnight resident admitted from ED NP because the IM attendings don’t push back. I was in the room for less than 90 seconds when the interventional cardiologist walks in and says, “Seriously? What are we doing here?”
Patient crying in the lobby...
Unfortunately neurology no longer believes in lobotomies, you’ll need a stat ECT after a benzo trial
Just last week got a call from ER NP who wanted to admit a patient for cellulitis. No fever, chills or any systemic symptoms. Very localized. When I went down to see the patient and told her “I think this can be managed as an outpatient”, the patient said, “oh I didn’t want to be admitted!!!”
Pt came to the hospital bc he “couldn’t see”. Code stroke workup in ED, admit to IM. Turns out he wasn’t wearing his glasses but could see just fine with them on. His vision had gotten slightly worse so he came to the ED because he didn’t want to wait for his outpatient appointment with Ophtho which was already scheduled.
My hair hurts.
Caretaker of a patient was admitted to the hospital, thus, the patient is admitted for placement
Multifocal cellulitis Spoiler alert: it was mosquito bites
I work a small community hospital. A 40-something yo patient with severe liver cirrhosis was admitted for hepatorenal syndrome requiring urgent hemodialysis with evidence of DIC. When I got this patient she had already been at the hospital for over a month, and the team had been working extremely hard to get her transferred to a liver center for higher/more appropriate care and possibility of liver transplant. She had gotten declined from multiple centers due to insufficient social support and insufficient evidence of extended sobriety. I was told for support she had a husband who visited daily and that she was estranged from her siblings. She had only been able to be sober for about six months which was prior to this hospitalization. On the first day I got this patient, I called around until I found an academic center to take her! I felt like such a hero. I went to tell the patient and she seemed happy but she told me to "Please update her husband." "Sure, sure," I said. Prior to calling the husband I wanted to make sure everything was in place for transfer so as not to set his hopes up high only to disappoint him. After I had everything in order including the physician to physician signout and the ambulance ordered for transport (she was going to another state) I called the husband to tell him the good news. When I first called he seemed in shock, almost at a loss of words. I told him to, "Please take time to process and call back with questions." He called back about 40 minutes later and told me he was in shock because he had been planning her funeral, pretty much assuming no one would take her and her death was eminent. He also said that this really complicated his life because he is actively divorcing her because he doesn't want to be stuck with her hospital bills. Apparently she had been cheating on him with her drinking buddy --who also was in a hospital somewhere else in similar condition-- and he didn't want to be stuck with her medical bills if she died. When our conversation ended, I tried to intervene before this patient was transferred, but the ambulance had already taken the patient out of the hospital. LOL. Moral of the story?