Hospitalization Scenarios

D- The patient arrived on time for her session and reports being stable on dose and haven't used any illicit drugs. This writer advised the patient that this writer was in fact in receipt of missed phone call about coming to the session at 10:30 am rather than 10 am due to her mother in the process of selling the house. This writer addressed with the patient about letter from CHR from her counselor, Jade Bray stating about the patient non-compliance with her appointment due transportation barrier. According to the patient, she is going through hardship as her mother is no longer taking her to her appointment as the patient says, " She's tired of bringing me everyone, Charlene. She complains about bringing me here and does not understand why I can't even get a bottle...:Like c'mon. What do I have to do?" This writer explained to the patient about TEAM decision, at which the patient disagree with the decision. This writer asked the patient about her "judgement." According to the patient, she feels she is making judgement by not engaging any further altercation with patient at the clinic, dosing daily, coming to her counseling session, and trying to get help from Chrysalis for

After the men came back they said they called an ambulance to take me to the hospital. Ten minutes later, the paramedics came in and got be and we left. On the way to the hospital one of paramedics asked what I did to my foot.

Due to an increase in depressive symptoms, suicidal ideation, homicidal ideation, poor insight, poor judgement, poor impulse control, harm to self, patient does meet criteria for IVC and inpatient hospitalization. TACT consulted with Dr. Osborne

The patient was placed on HOLD to see the writer to address his non-compliance with treatment. The patient was reminded about his Step 3 of the patient engagement. According to the patient as the writer reviewed the patient case history of his no show for counseling, group attendance, and continuously AWOL, the patient only response was, " I, know." The writer then inquired of the patient efforts to engage in mental health services through ICRC. The patient admits that he haven't done the intake when the deadline was extended for the third time. The writer discussed with the patient about the risk of facing an intent to discharge due to his non-compliance and addressed alternatives such as suboxone and transferring to a clinic in Massachusetts to accommodate the work location. The patient declines the writer's suggestion as he wants to remain with HCRC-Hartford due to the positive treatment and said. " You guys really care....I do not want to be discharge.....I, mean what is the process of the intent of discharge?" The writer explained to the patient about the appeal process as his record will be reviewed by the Practice Manager to determine as to whether or not to forward with the discharge or the discharge to be overturn.

Dr. Gentry requested an assessment for Kaitlin Bradley, an 19 year old female who presented to Randolph Hospital ER reporting suicidal ideation, with a plan, and symptoms of psychosis, and homicidal ideation. She stated " I plan to do some stupid shit". Ms. Bradley reports she has had suicidal ideation daily since the age of 10, She reports that in the past two weeks her suicidal ideation has gotten worse. She reports yesterday she was suicidal and reports if she was going to kill herself she would overdose no whatever pills she can get her hands on. Ms. Bradley reported cocaine and marijuana use, which was confirmed in her drug screening. She reports she came to the hospital so she would not harm herself. Ms. Bradley has a history of suicide

Patient is a 35 year old male presenting to the ED involuntarily as petitioned by his cousin due to threatening to shoot himself with a gun. At the time of assessment, patient denies feeling suicidal or having a plan. When confronted about admitting being suicidal and having a plan to nursing staff and TACT, Mr. Crowson stated "He is here because he is going through withdrawals and his mother is lying." The Mr. Crowson reports in the past year he has lost his father. Mr. Crowson reported wanting to receive Methadone from hospital to help with withdrawal symptoms. He expressed feeling body aches, stomach cramps, chills, irritability, angry, and verbally aggressive behavior. Patient refuses to finish full assessment.

Avoidable emergency department (ED) encounters places a significant burden on the health care system. Seniors 65 years or older have the highest rate of hospital encounters of any other age group (Bulut, Yazici, Demircan, Keles & Demir, 2015). The Center for Medicare and Medicaid (CMS) have placed stiff penalties on hospitals that are not able to reduce repeat encounters (“Coordinating better care & lowering costs”, 2017). These penalties result in the loss of guaranteed funding if the hospitals are not able to reduce readmission rates. Therefore, hospitals are seeking solutions to solving this challenge (“Coordinating better care & lowering costs”, 2017). Care transition teams are in place to help mitigate repeat encounters,

Patient presented to the ED via EMS after a attempted suicide by driving his car into a tree. Patient reports braking up with his girlfriend a month ago and experiencing depressive symptoms. He reports that his girlfriend and him had a 7 year relationship, which he shared a with a 6 year old daughter from the relationship. Patient expresses that in the past he has been verbal aggressive towards her and she has recently moved into er mothers home. The patient reports since her leaving he has been having suicidal thought. He reports that he never attempted suicide, however has had a history of depression and a verbally abusive father. The patient express a poor appetite, sleep, and loss in usual pleasure, which is praying for change in his relationship.

Anthony is a 32-year-old WM, single, never married with no kids who presents to CRU from CBI. He is GMH designated, but NT19. He has a hx of robbery, and he spent 2 and half years in prison. He stated he robbed the bank because he wanted to get shot by police. Pt. is originally from Kansas, and according to him, he has no friends in Arizona. Per collateral, he has a hx of cutting and hanging. He tried hanging himself whiles in jail. Upon admission, it was observed that client has a superficial cut on his left arm. He reported that the voices commanded him to cut himself. He endorses depression, AH, but denies DTO behaviors. He will benefit from medication stabilization and meeting with a provider.

Patient is a 53-year-old female who presented to the ED after a attempt to commit suicide by cutting both her wrist. Patient stated: "I don't care about my life, I can die and it would not matter to me." Patient becomes tearful and expresses when she was cutting her wrist she didn't die. LEO brought patient into the ED from DayMark recovery services under IVC. At the time of assessment, patient endorses feeling suicidal with a plan. Patient reports health, conflict with neighbors, and financial issues as the primary factors contributing to her current distress. Patient reports having a history of suicide attempts by overdose, the last being "years ago". Patient reports no hospitalizations from incidents. Patient reports a history of domestic

In terms of where America stands on medicine today, despite having the most expensive health care system, it lacks quality and efficiency in all voluntary measures. According to an op-ed on The New York Times newspaper it states, "… this country lags well behind other advanced nations in delivering timely and effective care." Essentially, what this does is shift health care systems' center of focus [patient engagement] to acute care, where a patient receives active but short-term treatment for severe injuries or illnesses. With that being said, the only thing left with a chance of hope is the betterment of national doctors to make that change —— change for a better health system. Those that are interested in the well-being of others, including themselves, by following these simple steps it will open up a path to become a phenomenal doctor.

Mr. Morris is a 36 year old male who presented to the ED with Suicidal ideation without a plan. Before the assessment QP received a call from the patient's mother who informed QP her primary concern with her son is his substance abuse and recent thought of self harm. She reports he has expressed suicidal ideation the past few weeks since he has returned to her home. At the time of the assessment Mr. Morris denies suicidal ideation, history of attempts, homicidal ideation, and symptoms of psychosis. He does reports a history of PTSD from seeing his uncle get killed in 1999, however no mental health hospitalizations. Mr. Morris states, "No, Not really thinking about harming myself, just situational stuff." He continues to state, "I just don't see the point of living sometimes, with all the stuff been going with me these past few months, but I have 2 daughter to live for and the people who do care about me." He reports consuming alcohol most of the day and feelings of depression for the past 3 weeks. His

During the time of assessment the patient presents drowsy. The patient reports during the time of assessment that he is not currently suicidal or homicidal. The patient reports that he hears voices telling him to kill him self and kill his wife. However, the patient reports that he loves his wife and do not wish to harm her. The patient reports that tonight that him and his wife got into an argument, however

Re-evaluate at Beaumont Dearborn the consumer refused to go inpatient and states that if that is our plan he does not want to talk to anyone because he is not crazy. The consumer was upset however, the writer explain to the consumer that our goal is to make sure he get connect with an outpatient provider for medication and treatment. The writer discuss with the consumer about Partial Hospital Program with Mobile Crisis Stabilization. The consumer admit that he does need help and medication but, does not want to go inpatient. The writer disposition for the consumer is PHP with Mobile Crisis Stabilization.

A study conducted by Twigg et al. (2016), exemplifies that adding assistants in nursing (AIN) to acute hospital wards has impacted negatively and increased adverse patient outcomes. The study revealed that there were three significant increases in unfavourable adverse outcomes which are, failure to rescue, urinary tract infections and falls with injury, as this is due to AINs caring for and completing tasks for patients not within their scope of practice.