Harbor:Placement patients

Effective 3/6/2023 per Dr. Goolsby (EM) and Dr. Thomas (IM) Chairs

  • EM physician responsibilities:
    • Evaluate for any medically necessary admission needs (lab abnormalities, AKI, dehydration, UTI, delirium, pain mgt, wound care)
    • Consult SW
    • Consult PT/OT ("Physical/Occupational Therapy Consult and Evaluation Inpatient" - no not use outpatient)
    • Place Interqual request and call UM
    • Set patient and family expectations
    • SNFs must hold the bed for 24 hours and can take the patient back to arrange for transfer to a higher level of care for longer-term needs as long as the current situation is safe for the patient
    • Notify DEM AOD of "placement pending" patient as soon as identified
      • AOD will confirm patient is appropriate for this pathway
        • AOD will notify the UR/SW/Inpatient Directors
    • PT/OT/SW/UR must be consulted at the time of placement pathway, but they will likely be in various stages of completion

TEAMS chat the following info to the AOD (if overnight, text at end of shift to confirm it was received):

  • Patient name, MRN#, ED Room #, Team (purple/green)
  • Brief clinical info (age, comborbidities), how the patient arrived to ED (family, EMS, as a trauma)
  • Reason for need for placement (e.g. can’t do ADLs, dementia, abuse, etc.)
  • Skilled nursing needs? Wound care issues?
  • PT/OT/SW/IQ all requested and what stages we are in.
  • DHS eligible, empaneled, type of primary insurance and secondary insurance.
  • At 1–2pm, care of the patient should be transferred to an inpatient team:
    • Sunday, Monday, Wednesday, Saturday - call next admitting team on the template
    • Tuesday, Thursday, Friday - call the hospitalist
    • DHS patients empaneled to Family Medicine will go to the FM service
    • The ED should use the "Place in Observation" order, NOT Request for Admit

Remind the admitting team to NOT complete the "ADMIT to INPATIENT" order on the multiple "admit" templates (this order creates the hospital admission icon which should not happen with these patients!)


  • Fine Print
    • Maximum of one patient per day (if a second arrives, they will be managed by the ED until 1pm the following day)
      • Ensure home meds are initiated if the patient will be in the ED for an extended time
    • After 48 hours in ED bed on Placement Pending status, patient will be admitted as an inpatient. UM staff will track duration of Placement Pending status.
    • DEM AOD will track placement pending patients (MRN, arrival date, discharge date, insurance, conversion to inpatient)


  • Other Placement Patient Considerations:
    • [Home Health] – take a few business days to arrange, options for wound care, PT or OT evals, home hospice, home safety, home infusions, home health nurse eval, etc.
    • DHS or MHLA patients may be admitted if unable to find timely placement from the ED.
    • Non-DHS or OOP placement patients CANNOT be admitted to Harbor, if there is no acute medical need.
    • No longer have ‘obs status’ anymore so these patients can NOT be admitted to ED hospitalist on short stay unless the insurance plan gives authorization.
    • Some general tips to help get these patients placed from the ED.
      • SW options: Housing for health, recup care, board and care, etc.
      • Physician may need to fill out some paperwork to initiate process, please do so.
      • Upon discharge, will need prescriptions in hand of all home medications.
      • UR/Insurance options: SNF, acute rehab, etc. will need PT/OT evals before placement.
        • If UR is suggesting a transfer to Rancho Los Amigos (RLA), then place the ‘consult to Transfer Center’ order. The Transfer Center is a county entity that helps transfer patients between county facilities.
      • Clarify if both are needed or just PT eval.
        • ED PT/OT evals for placement are given priority given the urgent nature.
        • If in doubt, just place the order for PT eval and another order for OT eval, and then call Rehab Services x67395.
          • If any issues, can call Leslie Porter, Director of Rehab Services, 3xx-880-3247
        • Patient's that need outpatient HD chair, coordinate with the HD social worker as well (through SW consult)
        • GeriPsych: If patient is on a 5150 (or vol w/ psych hx) and age =/>65yo with medical issues that need hospitalization, then could consider College Hospital's GeriPsych unit.

See Also