Harbor:CORE

Background

  • Any OOP patients needing observation or CORE services should be transferred to an in-network hospital if they are stable - Peterson 5/2016
  • Only patients with internal medicine (or family medicine) covered illness can be placed on obs. All other services require admission (or transfer) - Lewis 5/2016
  • If the hospitalist is capped (cap is 20 if single overnight hospitalist coverage, which includes Obs and CORE leftover from dayshift, new Obs or CORE, and new admissions), and you have a patient you’d like to place in Observation, CORE, or an admission:
    • Do not place the order for obs placement, CORE, or the ‘request for admit’ order. This becomes confusing for nursing who is actually managing the patient. Only place this order when you have discussed the patient and the care officially transfers to the inpatient/obs/CORE physician.
    • Continue to manage the patient until the next hospitalist shift starts (typically 7:30am) or the next medicine slot is available.
    • Do put in an Attending Admit Note at the time of the actual admit decision but document in your notes that patient is being held in the ED due to lack of hospitalist/Medicine capacity.

CORE

  • Admit for non-CHF edema, anasarca, or requiring significant diuresis (>10kg)
  • Psych can consult in CORE, or patient can be discharged from CORE to psych ED on patients requiring cardiac clearance

Chappell, 8/2017

CHF Disposition

  • If estimated <2 midnight stay, place in CORE
  • If estimated >2 midnight stay:
    • Admit to medicine service (telemetry) if all of the following are met:
      • Low suspicion for ACS (as determined by ED attending)
      • HR < 110
      • BP > 110
      • Creatinine <2.0 (unless ESRD on HD)
      • No BiPAP required at any time in the ED
    • Admit to C-team if the above criteria are not met or the patient is going to the ICU

5/29/19 - Dr. Daar (IM Chair), Dr. Thomas (Cardiology Division Chief), Dr. Lewis (EM Chair)

See Also

References

Authors:

Ross Donaldson