Harbor:Direct Admission after Hours: Difference between revisions

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*If a patient who appears stable presents to the ED stating they are a direct admission, they should be sent to ED registration
*Presents to the ED and is stable send to ED registration
**ED registration will confirm with bed control/patient flow that the appropriate paperwork has been completed
**ED registration confirms appropriate paperwork with bed control/patient flow
***If the patient was inadvertently registered prior to discovering they were a direct admit, they can be removed ("registration in error")
***If ED registered inadvertently make a "registration in error"
**If the paperwork has not been completed, ED registration will attempt to contact the admitting physician to complete the process
**If no paperwork  
**If they are unable to contact an admitting physician, the patient should be directed back to the router for entry into the ED process
***ED registration contacts admitting physician to complete
*Patients may be directly placed in CORE by cardiology without ED evaluation
***If unable to contact admitting physician, the patient is directed back to the router for ED visit
** They should receive a brief MSE on arrival to the ED in case there are unstable vitals or a delay in placement into a room in CORE
*Patients may be directly placed in CORE by cardiology
*All patients going to Observation must be evaluated in the ED with an ED Chart completed (unless they are placed in OBS directly by UCC;  cannot go direct from clinics, etc.)
** Should receive brief MSE on arrival to ED  
*'''Any inpatient direct admissions presenting before 8pm on Weekdays:  admitting physician directly contacts Bed Control (x2185) for Ward Beds or Patient Flow (x3434) for Tele/PCU beds'''
*No direct admits to OBS EXCEPT from UCC
**The Scheduled Admission Office (x2137) is open from 530am until 8pm, and admitting physicians should take stable patients there while awaiting a bed.  If no bed is obtained by 8pm, then the admitting physician will be contacted and their service should take the patient to the ED to wait until a bed is obtained.  They should be held in the WR and placed on the tracking board as a pre-arrival, but not registered in the ED as they already have admission orders.  
*'''Any direct admissions before 8pm on Weekdays:'''  
**Admitting physician directly contacts Bed Control (x2185) for Ward Beds or Patient Flow (x3434) for Tele/PCU beds
**Scheduled Admission Office (x2137) open from 530am until 8pm, stable patients go there while awaiting a bed.   
***If no bed by 8pm, then the admitting physician will be contacted and their service should take the patient to the ED to wait until a bed is obtained.   
***Hold in the WR and place on the tracking board as a pre-arrival,  
***Do not register in ED as they (already have orders)  
*** If the hospital capacity is limited, it is important that orders are placed as PLANNED, NOT ACTIVE, so they can be activated in any hospital location (this will allow a pre-admission that is boarded in the ED to have orders such as antibiotics completed while waiting for a bed)
*** If the hospital capacity is limited, it is important that orders are placed as PLANNED, NOT ACTIVE, so they can be activated in any hospital location (this will allow a pre-admission that is boarded in the ED to have orders such as antibiotics completed while waiting for a bed)
*'''If after 8pm on weekdays, or weekends and holidays:  Admitting physician completes "Clinic/Emergency/Urgent Admission Request Form" (can be obtained from ED registration window x2075/2076/2078 or Bed Control)'''  
*'''If after 8pm on weekdays, or weekends and holidays:'''  
**Admitting physician provides a copy of the request to ER Registration and they create a pre-admit FIN   
**Admitting physician completes "Clinic/Emergency/Urgent Admission Request Form" (can be obtained from ED registration window x2075/2076/2078 or Bed Control)'''  
**Admitting physician provides a copy of the request to Bed Control/informs location of patient to release bed (ER)
**Admitting physician provides to ER Registration -> create a pre-admit FIN   
**Admitting physician provides to Bed Control/informs location of patient to release bed (ER)
***UR (x3226) financially clears patient or calls to obtain authorization (if OOP) and informs Bed Control of approval or denial  
***UR (x3226) financially clears patient or calls to obtain authorization (if OOP) and informs Bed Control of approval or denial  
****If the patient is denied, UR informs the admitting physician and Bed Control of denial
****If the patient is denied, UR informs the admitting physician and Bed Control of denial
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Chappell 7/2016
Chappell 7/2016. Peterson 8/2019




Revision as of 23:28, 26 August 2019

  • Presents to the ED and is stable send to ED registration
    • ED registration confirms appropriate paperwork with bed control/patient flow
      • If ED registered inadvertently make a "registration in error"
    • If no paperwork
      • ED registration contacts admitting physician to complete
      • If unable to contact admitting physician, the patient is directed back to the router for ED visit
  • Patients may be directly placed in CORE by cardiology
    • Should receive brief MSE on arrival to ED
  • No direct admits to OBS EXCEPT from UCC
  • Any direct admissions before 8pm on Weekdays:
    • Admitting physician directly contacts Bed Control (x2185) for Ward Beds or Patient Flow (x3434) for Tele/PCU beds
    • Scheduled Admission Office (x2137) open from 530am until 8pm, stable patients go there while awaiting a bed.
      • If no bed by 8pm, then the admitting physician will be contacted and their service should take the patient to the ED to wait until a bed is obtained.
      • Hold in the WR and place on the tracking board as a pre-arrival,
      • Do not register in ED as they (already have orders)
      • If the hospital capacity is limited, it is important that orders are placed as PLANNED, NOT ACTIVE, so they can be activated in any hospital location (this will allow a pre-admission that is boarded in the ED to have orders such as antibiotics completed while waiting for a bed)
  • If after 8pm on weekdays, or weekends and holidays:
    • Admitting physician completes "Clinic/Emergency/Urgent Admission Request Form" (can be obtained from ED registration window x2075/2076/2078 or Bed Control)
    • Admitting physician provides to ER Registration -> create a pre-admit FIN
    • Admitting physician provides to Bed Control/informs location of patient to release bed (ER)
      • UR (x3226) financially clears patient or calls to obtain authorization (if OOP) and informs Bed Control of approval or denial
        • If the patient is denied, UR informs the admitting physician and Bed Control of denial
        • Admitting physician then must decide whether this is urgent and needs to be seen in ED and transferred to in-network hospital or stable for outpatient treatment
        • If patient is DHS (approved), admitting physician inputs the admitting order on the pre-admit FIN
  • ER Physician will document the patient's presence in AWR/ED as a Pre-arrival with name and patient location (AWR or room *) with brief note with admitting service and physician to contact for questions (pager *)
    • Stable patients should be placed in one of the internal waiting rooms and until the upstairs bed is available; reassessment should occur per nursing protocol (q2 hours for ESI 2-3)
    • If a patient is in any way unstable or requires immediate intervention or cardiac monitoring, they should be registered and seen as an ED patient and the admitting team should be notified of the change in patient status as soon as possible


Chappell 7/2016. Peterson 8/2019


See Also

References

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