Scanning sources…acquiring signal · establishing uplink
Day 0 — 14:32
9-1-1 dispatch, EMS response, field triage, trauma center transport
EMS arrives 8 min post-collision. GCS 14, bilateral femur deformity, tachycardic (HR 118). Traction splints applied. Ohio trauma triage protocol: ISS criteria met → Level I trauma center direct transport. 22-min ground transport.
No payer involvement at this stage — emergency stabilization under EMTALA
Eligibility not yet verified; trauma activation proceeds regardless of coverage status
Day 0 — 14:54
Trauma team activation, primary/secondary survey, FAST exam, CT imaging
Level I trauma activation. Primary survey: airway intact, bilateral femur fractures confirmed. FAST negative for free fluid. CT head/c-spine negative. CT pelvis: no acetabular involvement. Labs: Hgb 10.2, lactate 3.1. Trauma activation fee billed (S9083). Eligibility verification initiated via Availity 270/271.
Day 0 — 18:00
Bilateral intramedullary nailing of femoral shaft fractures
OR case: bilateral closed reduction and IM nailing under general anesthesia. 3.2 hours operative time. EBL 800 mL, 2 units PRBCs transfused. Intraoperative fluoroscopy confirms acceptable alignment. Post-op to SICU for monitoring.
Day 1–5
SICU monitoring, pain management, PT/OT initiation, concurrent UM review
SICU days 1–2: hemodynamic monitoring, DVT prophylaxis, pain management (PCA morphine → oral). Step-down to floor day 3. PT initiated day 2: bed mobility, transfers. CDI captures ISS 22, bilateral fractures, blood loss anemia. Molina concurrent review initiated day 3.
Day 5–7
Functional assessment, SNF evaluation, DME orders, discharge disposition
FIM score: 62/126 (moderate dependence). Non-weight-bearing bilateral lower extremities. Lives alone, 2nd floor walk-up — home discharge not safe. Case management initiates SNF referral. DME: wheelchair, walker, shower chair. PT recommends 3–4 weeks SNF-level rehab. PA submitted for SNF and DME via Availity.
Day 7–28
Skilled nursing facility rehabilitation — PT/OT/wound care
Admitted to SNF day 7. PT 5x/week: progressive weight-bearing per orthopedic protocol. OT 3x/week: ADL retraining, transfer technique. Weekly FIM tracking: 62 → 74 → 88. Surgical follow-up at 2 weeks: x-rays show progressing callus formation. Molina extends SNF authorization at day 21 review.
Day 28–90
Outpatient PT, progressive weight-bearing, return to function
Discharged from SNF day 35. FIM 94/126. Partial weight-bearing bilateral. Outpatient PT 3x/week. 6-week follow-up: full weight-bearing authorized. 12-week follow-up: return to light duty work. Final FIM 118/126. Molina closes case.