HELP!!! My supervisor thinks WEAKNESS is a chief complaint for dialysis calls

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code3club

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I got in an hour long yelling match with my supervisor, he thinks WEAKNESS is an acceptable chief complaint for a dialysis call!!!!! He will not listen to me and it is frustrating me to no end. I know what the chief complaint should be ESRD, Hemodialysis, Dialysis Tx, Renal Disease, Life sustaining hemodialysis take your pick but NOT WEAKNESS. How can I convince my supervisor he is wrong

HELP!!!!!​

Thanks, DB
 
First, welcome to EMTLife!

Why do you need to fight this battle? It seems like you already tried to discuss the topic and it wasn't productive.
 
Hour long yelling match and you are still employed?

Anyways, he is your supervisor and is this a battle you NEED to fight? Does it make a difference? The answer is no it does not and it only causes you grief and stress.

Why not live to fight another day and let this one go?

FYI, most dialysis patients are weak which is why you are transporting them instead of them going by personal vehicle (bilateral amputations excluded).

So to be blunt, yes their chief complaint could indeed be weakness and their past medical history will show ESRD and then in your notes when you justify your trip via ambulance your run report makes sense to the auditor.

They will read an ESRD patient with weakness is being assisted to dialysis.
 
My ESP is telling me that billing is kicking back tickets that use "ESRD" as a justification for ambulance transport, hence the supervisor wants people to use something else that will guarantee to get the bills paid.

Ok, here is the deal.

Do all dialysis patients need ambulance transport? No

Since every dialysis patient does not use ambulance transport "ESRD" is not self explanatory enough to justify paying for an ambulance.

So presumably the dialysis patients who are using ambulance transport have secondary conditions that necessitate their transport by ambulance.*

That is the condition that needs to go down on the PCR.

For example. "The patient is a 75 yo female who is being transported from Acme SNF to Acme dialysis clinic. The patient is being transported via ambulance because they have R sided paralysis due to a CVA and they have mild dementia, and they are unable to safely sit in a wheelchair without one on one supervision."

Or "The patient is a 75 yo female who is being transported from Acme SNF to Acme dialysis clinic. The patient is being transported via ambulance because they are unable to sit in a wheel chair or transfer without 2 person assist due to dementia and chronic weakness due to ESRD, cancer and general poor health".



*Or they or their family is demanding, or their MD is a lazy twit. Not wanting to wait for the WC van is not a justifiable excuse to go by ambulance, although if you bully your MD enough he might sign the PCS.
 
The fail in your supervisor is strong, you need to remove yourself from it before you are drained young one
 
If the C/C was weakness the Patient should be transported to the ER because that implies that the weakness is unusual for that patient. The C/C is what the patient is being treated for.

Medical necessity however is why the patient can not go by a wheelchair can and must have an EMS stretcher. The medical necessity is, "Patient requires EMS stretcher due to weakness and right sided hemiparesis secondary to CVA and prolonged bed bound state causing muscular atrophy; this makes the patient posturally unstable and unable to support self in wheelchair and unable to transfer self requiring 2 persons to move and full assistance with ADL's. Patient also has dementia and attempts to stand on his own causing patient to be a fall risk due to above weakness and needs supervision while en route to prevent patient from standing during transport." or whatever is causing their weakness blah blah blah *sets Medicare on fire and dances on it's ashes*
 
Frozennoodle said:
If the C/C was weakness the Patient should be transported to the ER because that implies that the weakness is unusual for that patient. The C/C is what the patient is being treated for.
Click to expand...

I disagree. Due to ESRD, they need dialysis 3 x a week or whatever their rotation is. As the time for dialysis approaches, they are becoming weak...this weakness is normal for ESRD patients...this is one of the symptoms on a very basic level.

Therefore to go get their ROUTINE treatment which will resolve the weakness, it is entirely appropriate to put weakness as a CC without the need for an ER.
 
I agree that there is no need for an ER unless something is significantly wrong or different, and even then I would likely let the dialysis RN make the call unless it was something obvious, like a new onset CVA. However, I still maintain that ESRD is an insufficient explanation. After all, some patients drive themselves to and from treatment.
 
i guess they could be complaining of chronic weakness due to their ERSD.. so then that would make if their C/C.

a persons c/c doesnt always have to be acute

my C/C right now is muscle soreness cause of the gym! (stupid deadlifts :( )

i do agree with the folks above that putting only ESRD with out further explanation is insufficient for billing.
 
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akflightmedic said:
I disagree. Due to ESRD, they need dialysis 3 x a week or whatever their rotation is. As the time for dialysis approaches, they are becoming weak...this weakness is normal for ESRD patients...this is one of the symptoms on a very basic level.

Therefore to go get their ROUTINE treatment which will resolve the weakness, it is entirely appropriate to put weakness as a CC without the need for an ER.
Click to expand...

You misunderstood my meaning. If I call EMS for chest pain my C/C is chest pain. If I call EMS for transport to dialysis my C/C is dialysis tx secondary to ESRD. The reason I need a stretcher is because of my chronic weakness. If I needed my weakness resolved I would go to the ER because it's new or more severe than what my norm is and then it would be my C/C. Dialysis doesn't treat weakness, in fact it induces it. Dialysis treats ESRD.

The weakness is the medical reason the person needs a stretcher for transport and not a wheel chair ergo, "medical necessity" The reason for the for the transport, or the C/C, is dialysis treatment.


What was the reason you were called out? To treat weakness or to bring someone to dialysis.
 
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Hour long yelling match and you are still employed?
Click to expand...

Damn...I was going to say that. Rule #1: If it's not going to harm a patient or someone else, don't get bent out of shape over it.
 
code3club said:
I got in an hour long yelling match with my supervisor, he thinks WEAKNESS is an acceptable chief complaint for a dialysis call!!!!! He will not listen to me and it is frustrating me to no end. I know what the chief complaint should be ESRD, Hemodialysis, Dialysis Tx, Renal Disease, Life sustaining hemodialysis take your pick but NOT WEAKNESS. How can I convince my supervisor he is wrong
Click to expand...

Is the patient complaining of weakness? If so, that's the chief complaint.




akflightmedic said:
Hour long yelling match and you are still employed?
Click to expand...


To be fair, I got in a 45 minute long argument / debate / discussion with my station "captain" last week over EMS, the future of it, what out job is, "you call we haul", etc etc. Got heated, but all was good as we stayed respectful.
 
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Weakness is an entirely appropriate C/C. ESRD is a disease process, it is not a C/C. Chief Complaint is just that, the chief complaint as provided by the patient. When you enter the C/C, that's what you should be entering. Medical history is not a chief complaint, but it could be the cause of the C/C such as this situation.

Your patient is weak because of End Stage Renal Disease. His chief complaint is weakness.

I would suggest that you do what your supervisor instructs you to do or else look for a new place to work because you aren't doing yourself any favours by trying to force the company to bend to your will. It is you who must get your stick out of your *** and bend to theirs.
 
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Point to ponder: Which is more important for a scheduled transport, a "chief complaint" or a "reason for transport?"
 
JPINFV said:
Point to ponder: Which is more important for a scheduled transport, a "chief complaint" or a "reason for transport?"
Click to expand...

What is, reason for transport?
 
WOW!!!!! What are EMT instructors teaching these days? A CC is simply the reason why you were called in the first place. For example: You are called to the home of a 71 yo PT complaining of chest pain. After your assessment you find the PT has a LBBB, a history of MI's. The CC is still CHEST PAIN!!!!! Of course you not the 12 lead findings and the PMHx in the narrative but the CC does not change. If you PT calls the ambulance to Tx for Dialysis because she is too weak to drive guess what, Her CC is WEAKNESS!!!
 
TransportJockey said:
What is, reason for transport?
Click to expand...


The reason the patient is being transported. At both companies that I've worked for, the "chief complaint" box was actually titled "Chief complaint/reason for transport." It's very possible, for example, that a patient going to or from dialysis or between hospitals or nursing homes, or any other sort of scheduled non-emergent transport doesn't have an actual complaint at the moment of transport. Just because the patient is in a position where there is medical necessity for ambulance transport does not mean that the patient is actively complaining about anything. I agree that "ESRD" or "dialysis" is not a "chief complaint," but both of those valid reasons for transport. To me, trying to saddle every routine transport with a "chief complaint" is simply trying to hammer a square peg into a round hole, and doing it needlessly.
 
crazycajun said:
If you PT calls the ambulance to Tx for Dialysis because she is too weak to drive guess what, Her CC is WEAKNESS!!!
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Really? The patient who is chronically weak is complaining about weakness 6 times a week?
 
JPINFV said:
The reason the patient is being transported. At both companies that I've worked for, the "chief complaint" box was actually titled "Chief complaint/reason for transport." It's very possible, for example, that a patient going to or from dialysis or between hospitals or nursing homes, or any other sort of scheduled non-emergent transport doesn't have an actual complaint at the moment of transport. Just because the patient is in a position where there is medical necessity for ambulance transport does not mean that the patient is actively complaining about anything. I agree that "ESRD" or "dialysis" is not a "chief complaint," but both of those valid reasons for transport. To me, trying to saddle every routine transport with a "chief complaint" is simply trying to hammer a square peg into a round hole, and doing it needlessly.
Click to expand...

JP, think Jeopardy. I honestly do know what 'reason for transport' means on an IFT chart :p
 
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