The Art of the Refusal

Why are we holding this class?Patient AdvocacyWhat is best for the patientEducation of the patientReassure the patient that their choices are right and meet their needs

Why are we holding this class?Protection for the paramedic

Helping the paramedic to have the skill(s) to guide the patient to make good choices

Helping the paramedic to make sure that their decisions on refusals are legal and defensible

Helping the paramedic to make sure they are following Dr. Riccio’s direction as the Medical Director of SMFRA.

Protocols we’re bundling…0007 General Guidelines: Patient Determination

0008 General Guidelines: Patient Non-Transport or Refusal

4015 Alcohol Intoxication

4012 Altered Mental Status

Presentation of Refusal Bundle

Go to Refusal Bundle in EMS Bureau Folder:

P Drive > EMS Bureau > Training > Company Training > 2014 Company Training > The Art of the Refusal > Copy of Refusal Bundle

Assessing Decision Making Capability

Assess Decision Making Capability

Are they a minor?  

Are they clinically sober?  

Do they slur their words?  

Is their gait ataxic?  

Do they make their own decisions?  

Who makes decisions for them?  

Do they understand nature of incident?

Do they understand the risks?

Have a plan if their condition deteriorates?

Assess Decision Making

Capability

Discussion of ARM Car Consult Better disposition for the patient

Contacting ARM Car by Nextel early (potentially prior to their arrival)

What can the ARM Car do for the paramedic and the patient on scene?

Talking about better disposition - Dollars & Sense – Six easy ways to decrease your out-of-pocket health care expenses (Cigna flyer)

1. Utilize In-network care

2. Utilize Urgent Care Average urgent care center

cost - $131 Average hospital ER cost –

$1523

3. Utilize convenience care or retail sites (Little Clinic in King Soopers)

Average convenience care clinic cost - $61

Average hospital ER cost - $1523

Dollars & Sense cont…4. Lab and Pathology tests

Average lab cost - $24 Average outpatient hospital lab cost - $48

5. Radiology services (MRI or CT scan) Average independent radiology facility cost - $591 Average outpatient hospital cost $1198

6. Colonoscopy, endoscopy, or arthroscopy Average freestanding surgery center cost - $1438 Average outpatient hospital cost - $2821

The Plan

Plan - "The Art"        Step 1 - Acknowledge their complaint     Step 2 - Assess their issue/complaint     Step 3 - Help them make an informed decision of what to do (DISCUSS) Do they understand possible complications?    

Make a plan with them in case things get worse  

Step 4 - Discuss options:    

ARM Car Consult    

Refusal    

Transport    

Step 5 - Awesome biophone report that covers physical assessment, decision making capability, and plan for the patient with the doc!

 

Discuss Plan - see box below

Documentation if a Refusal

Documentation Required if a Refusal    

Document the elements of the patient's decision making capability Document the patient's complaint      

Document the patient's understanding of possible complications Document the patient's plan if things get worse  

Document any concerns the doc has from biophone report Document name of doc authorizing refusal    

             

             

PCR Needed