Peter to answer your question about what I did for her about seeking direct admission. I told her I'm leaving to go to Florida the next day visiting family and she would have to talk to my coverage (who might agree or might ask her to go to the E.D.)
My general policy is that I will direct admit patients only from my office anytime during regular hours, 6a-4p (unless I need further workup or stabilization in the E.D. in which case I send them there).
If a patient is home, I will only direct admit them if it's a problem I've seen them for very recently (like that same day or the day prior) and is something that is relatively stable. Example is the out patient pneumonia patient who has seen me, been on Levaquin for 3 days and still coughing up blood and has fever, and is vomiting and can't keep down fluids. I'm comfortable direct admitting them to the floor and seeing them a few hours later.
Our hospital requires that we see them within 4 hours of a direct admit from home, or 24 hours from orders called into the E.D., or 24 hours from direct admit from the office. I won't admit unstable patients from home to the floor.
And in the case of this patient, I haven't seen her at all, she has received the only advice from me after 8pm.
That's what I found most annoying is that she was having all of her problems during the day, but only found the time to call me well after office hours and well after the pharmacies were closed.
