Emergency Department to Medicine Admission Process

1/8/2015

Background: In the ED, one of the process goals is to efficiently admit patients that need inpatient care. Due to the complexities of a teaching hospital with multiple specialty services within medicine and surgery, there are delays to identifying the correct admitting service thus resulting in delays in placing an admission order. As the ED volume and admission volume increases, it becomes more important to remove non-essential delays to admitting a patient to their appropriate inpatient destination.

Currently, the difference in time between making the decision to admit and entering an admit order is over 100 minutes for General Medicine (University).

Goal: To admit an ED patient (defined as entering an EPIC admit order) within 30 minutes of speaking to an inpatient service after ED Decision to Admit

Standard Work Flow
When the ED makes the “decision to admit” a patient and places a page to an admitting service, those patients can fall into 3 categories. For each category, the process is described after first referring to the ED Admissions Grid to determine appropriate admitting service.

 

Obvious admissions:

ED physician (resident/attending) pages admitting team and presents the admission. For these patients where it is clear patient will benefit from further inpatient care, an attending name of service is provided to the ED physician during that 1st call. ED physician then places Admit Order in EPIC without waiting for patient to be seen by Medicine service.

 

Obvious admission but unclear which service should take patient:

ED first makes best judgment as to the appropriate admitting service based on the Admission Grid. During the call with the admitting service, if after the presentation of the case, the resident believes their team is not the appropriate service, the resident will provide their attending name, then have 30 minutes to identify and call back with the attending name of the appropriate accepting service. After 30 minutes, if there is no alternative service has been identified, ED will admit to the first service called to expedite the bed request while issue can still be resolved without delaying bed request for the patient.

 

Admission challenged:

If medicine service resident is challenging the need for admission, then the resident has opportunity to collect further information within 30 minutes of the presentation. The medicine resident shall still provide attending name of the service during the call so that if there is lack of resolution after 30 minutes, the ED team can escalate to an attending to attending discussion.