This is a story about a patient who was admitted to one of our Tapestry health facilities from a local hospital. It’s especially timely right now, because the Centers for Medicare Service (CMS) is debating whether or not to allow nursing homes to conduct admission examinations via telemedicine. This story perfectly explains why these examinations are so important.
It was a typical admission, the kind that come in on a Thursday afternoon or a Friday when hospitals a
re doing their best to discharge patients before a weekend. This patient had been in the hospital for a fairly routine orthopedic procedure, a hip replacement. But when the patient arrived at the facility, they did so with a prescription for a very powerful cardiac medication. Had this been a typical facility without a staff doctor in the house, the medications would have been administered according to the hospital instructions and the patient would probably not have been seen by a physician for at least several days. But this was a TapestryHealth facility and our clinician conducted an examination immediately u
pon arrival, along with what for Tapestry is a routine medication review. Why was a hip replacement patient being given powerful antiarrhythmic medication when the chart indicated no cardiac problem while the patient was there? Even more frightening, this particular medication given when not absolutely required could actually trigger a catastrophic event. She immediately called the hospital but it wasn’t until the following Monday that she got a return call. Not willing to wait, she called the patient’s pharmacy for a medical history and spoke to the patient himself about what medications he had taken in the past.
Based on her examination of the patient and his medical history, our clinician prescribed a new course of medication, one that was appropriate for the patient’s current condition. She followed up with the patient over the weekend to be sure the medication was doing its job, updated the patient’s records, worked with the facility nursing staff to prepare an appropriate care plan, and eventually spoke with the hospital about the wrong medication being prescribed. Fortunately, this story had a happy ending – a healthy patient recovering fully from hip replacement. But it could easily have gone the other way if not for the facility having 24/7 access to a dedicated board-certified clinician who could see their new patient as soon as he was admitted.