Case Management

Sneak peek: Team struggles to arrange outpatient dialysis treatment for noncompliant patient

Case Management Weekly, January 5, 2011

Gerald is a 47-year-old male with a history of drug abuse and suicide attempts. He also presents to the ED at least twice weekly. 

Gerald presents to the General Hospital (GH) ED complaining of shortness of breath, fluid overload, and urgent hemodialysis. The attending physician admits Gerald for inpatient care and diagnoses him with end-stage renal disease. 

Gerald has a history of congestive heart failure, a 47% ejection fraction, end-stage renal disease, severe hyperparathyroidism, hypertension, dilated cardiomyopathy, lupus, and is anemic. He also is noncompliant with respect to medication and dialysis treatment. 

Gerald has multiple comorbidities. His family is not involved in his treatment or care regimen, and he frequently presents to the GH ED for emergency dialysis treatment. Although GH can provide emergency dialysis treatment, it is not licensed to provide outpatient dialysis treatment. A neighboring hospital is licensed to provide outpatient dialysis, but Gerald prefers the staff at GH. He was also kicked out of several dialysis centers for violent behavior.

Check out the January 2011 issue of Case Management Monthly to learn more. You also can discover the benefits of becoming a Case Management Monthly subscriber.

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