The ED or primary care doctor describes a new patient you’ll be admitting. Oh, and there’s one other thing: The patient has a chronic disability and is dependent on family members for daily care.
Naturally your thoughts turn to social issues and discharge planning. But there’s another problem for the hospitalist here: How will you know when the patient is at his or her baseline, or recognize changes in the neurological status?
Most of us are pretty comfortable with spinal cord injuries. Tell us the level and we can figure out that a C7 is at risk for pneumonia, a T12 can be independent but needs to watch for decubiti, and so on. But advanced multiple sclerosis, cerebral palsy and head injury patients can be very individual in their disabilities. Getting a clear idea from the patient and/or family of what the patient can usually do will allow you to realize when there’s a new problem.
I recently reviewed a case in which a patient developed a new neurological problem that was missed in its early stages because the doctors and staff were unfamiliar with the already disabled patient. Signs and symptoms that would have raised red flags in most patients were ignored because everybody assumed those were present before the patient came to the hospital. As a result, the patient lost so much function that home care was no longer possible.
Yes, you have two or three more admissions waiting while you see this one. But a few questions about a disabled person’s mobility, continence and ability to communicate at home will not only allow you to spot new problems early on, but help with discharge planning in a few days.