trust your guts

I was pretty sad today. I transferred a patient from the ICU to a SNF yesterday. He has been in the ICU for almost 2 months. He was very very sick, I'll spare the details. He was making improvements and didn't really need to stay in the ICU but a long term acute care hospital would have been more appropriate. However, his insurance did not cover that stay so he went to a SNF. I found out today that he decompensated en route to the SNF and was back in a different ER 6 hours after transfer. I feel like an irresponsible doctor. I know it wasn't ultimately my decision to transfer, and we had been hanging onto him longer than we should have. But it really sucks. I had been talking to his brother daily on the phone. This makes me really angry about the health care we can provide and the limitations to the care that is appropriate. I feel like I should have been a stronger advocate for my patient despite pressures to transfer from case management and my resident. hmmm. lesson learned for when I do have the final say. If I feel nervous about transferring someone, maybe best to keep him a little longer.