Beyond the Bedside, Behind the Screen: Nursing Judgment Still Matters
I was reviewing a request for admission to a long-term acute care hospital on behalf of a payer. The patient was on a ventilator, and the coverage criteria required documentation of attempted ventilator weaning, including the results of the three most recent attempts. The record indicated that weaning had been attempted, but I could not initially locate those results. Without the required documentation, the request would have been denied. Rather than treating the gap as the whole story, I searched further in the electronic medical record. I found the missing results and could support the requested admission under the applicable criteria.
As part of my role, I followed long-term acute care (LTAC) patients through continued-stay reviews, so I was able to follow this patient’s progress after admission. Over the course of the stay, the patient was successfully weaned from mechanical ventilation and decannulated.
I had not examined the patient at the bedside, but I had recognized an incomplete clinical picture and kept looking. The clinical reasoning that led me to recognize the problem came from the same nursing foundation I had developed years earlier. The criteria mattered: I could not substitute a feeling for evidence. My experience mattered, too: it prompted me to ask whether the […]
