Harbor:Admitting a patient
Admitting a Patient
We have admitting privileges to all hospital services. Once a patient is admitted by us, the service has two hours to write admitting orders or the ED will do it for them. We should hold services to the two-hour time limit as closely as possible in order to expedite ED flow.
If you are not sure if a patient needs to be admitted, you may always consult the service instead. Please make sure that the residents make it clear to the service that they are either admitting or consult on a patient.
When admitting patients, please follow the "Admission and Consultation Guidelines" as closely as possible to determine which service to admit to. If not listed, emergency department determines the admitting service.
The admission process steps below should be followed in strict order to avoid admission errors.
- Place an 'Interqual Request' to begin Utilization Review (UR) process.
- Resident or nurse practitioner in RME must discuss the case with the attending, who must agree with the admission.
- The attending must write a note in the orchid specifying the following three things:
- Service to admit to (if to the general surgical service, It should be listed as "Acute-Care Surgery" for the admitting service, even though the trauma service officially does all of our consults in the emergency department. Observation patients are not technically admitted, for these put "OBS", and for CORE patients put "CORE".
- Reason for admission: if the service itself made the decision to admit, then put "at request of ______ (Service). Otherwise note the brief medical indication for admission. "Placement" may be used as a reason to place the patient observation service; we do not admit placement patients to the hospital. You may put a more detailed justification in your attending note.
- Level of care (Ward, PCU, ICU, Tele)
- Once the admission note is placed by the attending, then the resident may contact the service to inform them of the admission. At this time the service can discuss the admission with emergency physician if they feel the admission is not justified or the patient should be admitted to another service. It is especially helpful if they have other information about the patient which may be important for a disposition decision. The final decision rests with emergency physicians, but if there is significant disagreement the ED attending should be involved in the discussion.
- Once the service has been informed, the ED resident should place the order "Request for Inpatient Bed", which defines the time of admission decision. From this time the admitting service has two hours to disposition the patient. They may discharge the patient, write admitting orders for the patient, or transfer the patient to another service. ED department physicians should not be involved in these transfers; once the patient has been transferred to a new service, that service must contact the ED at which time a new two-hour period is established. The admitting service is responsible for the care of the patient once the "Request for Inpatient Bed" order is placed
- if the admitting service does not write admitting orders within the two-hour timeframe, the ED resident should contact the admitting service, or if unable, have made a reasonable effort to contact it makes service to inform them that the ED is going to write admitting orders. The ED resident then should proceed to write a brief admitting order set. ED attendings need to encourage the writing of admission order sets by the ED as soon after the two-hour time limit is up in order to expedite flow.
