Harbor:Direct Admission after Hours

• If a patient who appears stable presents to the ED stating they are a direct admission, they should be sent to ED registration
  • ED registration will confirm with bed control/patient flow that the appropriate paperwork has been completed
    • If the patient was inadvertently registered prior to discovering they were a direct admit, they can be removed ("registration in error")
  • If the paperwork has not been completed, ED registration will attempt to contact the admitting physician to complete the process
  • If they are unable to contact an admitting physician, the patient should be directed back to the router for entry into the ED process
• Patients may be directly placed in CORE by cardiology without ED evaluation
• All patients going to Observation must be evaluated in the ED with an ED Chart completed (no direct placements on Observation by clinics, etc.)
• 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
• 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)

1. Admitting physician provides a copy of the request to ER Registration and they create a pre-admit FIN
2. Admitting physician provides a copy of the request to Bed Control/informs location of patient to release bed (ER)
   1. UR (x3226) financially clears patient or calls to obtain authorization (if OOP) and informs Bed Control of approval or denial
      1. If the patient is denied, UR informs the admitting physician and Bed Control of denial
      2. 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
      3. If patient is DHS (approved), admitting physician inputs the admitting order on the pre-admit FIN
3. 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 #)
   1. 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)
   2. 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
4. 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.
   1. 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)

Chappell 7/2016

See Also

• Harbor:Operations manual