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Hospitalized, but Not Admitted: Admission Status

Hospitalized, but Not Admitted: Admission Status

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• S: Knee pain O: Knee pain A: Knee pain P: Knee<br />

replacement: denied!<br />

• Patient established care for knee pain due to OA 18<br />

months ago. At that time, a trial of NSAIDS and APAP for<br />

6 months produced no benefit. Three intraarticular<br />

steroid injections produced no relief, nor did six months<br />

of physical therapy. Thus, arthroplasty is indicated.<br />

• “Admit to OBS for rule out MI”: a nightmare!<br />

• While the ECG and biomarkers are normal, her risk<br />

factors of smoking and diabetes suggest a high risk of<br />

cardiac chest pain. I am concerned about the short-term<br />

risk of death from ACS. Thus, further urgent evaluation<br />

is warranted.

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