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CMW tip of the week: Work with patients who demand admission

Case Management Weekly, August 12, 2009

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Occasionally, patients come to the ED expecting to be admitted. When their medical work-up is normal and the physician informs them that they are discharged, they refuse to leave. These patients are often older people who live alone and do not feel they should go home. The case manager is often consulted to help with discharge options. After a patient is given options for increased home services or respite placement, or if the patient has a previous skilled nursing facility qualifying hospital stay, and the patient still refuses to leave, it may be necessary to issue him or her a hospital issued notice of noncoverage (HINN). This document informs the patient that he or she does not meet the criteria for an inpatient stay and that should the patient still choose to be admitted, he or she will be financially responsible for all aspects of the stay.

Editor’s note: This tip comes from Emergency Department Case Management: Strategies for Creating and Sustaining a Successful Program available online at HCMarketplace.com.

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