Harbor:Direct Admission after Hours - Revision history

Bchap23 at 16:01, 10 March 2026

2026-03-10T16:01:16Z

@@ Line 4: / Line 4: @@
 *** Ask: “Is the patient unstable?  What immediate workup does the patient need in the ED that cannot be done once admitted?”
 **** Exceptions: emergent/urgent work up and stabilization, need immediate cardiac monitoring
-** If it seems like the patients does not need the ED and should be a direct admission, '''escalate''':
+**<big><big>If it seems like the patients does not need the ED and should be a direct admission, '''escalate''':</big></big>
 *** '''ED Attending to Clinic Attending'''
 **** '''Clinic Attending to Clinic Medical Director and Clinic Nursing Director'''
@@ Line 10: / Line 10: @@
 ** Do not spend time trying to walk them through the process outlined below (it is only for reference).  The Clinic Medical Directors should be able to walk their teams through the direct admission process.
 *** '''Clinic Physician Job Aid from Dr. Mendez''' 3-2025:  [[File:DIRECT ADMIT FROM CLINIC.pdf|thumb|Direct Admit from Clinic Job Aid 3-2025]]
 *'''Business hours process: Any direct admissions before 8pm on Weekdays (Policy 372):'''
 ** If symptomatic, patients are coming from a clinic within the hospital building, they should send the rapid COVID test to the lab and hold stable patients in clinic until a bed is available;  patient flow will attempt to place in isolation room in 5E until swab is resulted

Bchap23 at 23:21, 9 March 2026

2026-03-09T23:21:01Z

← Older revision		Revision as of 23:21, 9 March 2026
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	*'''Business hours process: Any direct admissions before 8pm on Weekdays:'''		*'''Business hours process: Any direct admissions before 8pm on Weekdays (Policy 372):'''
	** If symptomatic, patients are coming from a clinic within the hospital building, they should send the rapid COVID test to the lab and hold stable patients in clinic until a bed is available; patient flow will attempt to place in isolation room in 5E until swab is resulted		** If symptomatic, patients are coming from a clinic within the hospital building, they should send the rapid COVID test to the lab and hold stable patients in clinic until a bed is available; patient flow will attempt to place in isolation room in 5E until swab is resulted
	**Admitting physician directly contacts Bed Control (x64010) for Ward Beds or Patient Flow (x65620) for Tele/PCU beds, clinic admissions get priority over ED admissions.		**Admitting physician directly contacts Bed Control (x64010) for Ward Beds or Patient Flow (x65620) for Tele/PCU beds, clinic admissions get priority over ED admissions.

Bchap23 at 18:31, 11 February 2026

2026-02-11T18:31:23Z

← Older revision		Revision as of 18:31, 11 February 2026
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	*'''Business hours process: Any direct admissions before 8pm on Weekdays:'''		*'''Business hours process: Any direct admissions before 8pm on Weekdays:'''
	** If patients are coming from a clinic within the hospital building, they should send the rapid COVID test to the lab and hold stable patients in clinic until a bed is available		** If symptomatic, patients are coming from a clinic within the hospital building, they should send the rapid COVID test to the lab and hold stable patients in clinic until a bed is available; patient flow will attempt to place in isolation room in 5E until swab is resulted
	*** Patient flow will attempt to place in isolation room in 5E until swab is resulted
	**Admitting physician directly contacts Bed Control (x64010) for Ward Beds or Patient Flow (x65620) for Tele/PCU beds, clinic admissions get priority over ED admissions.		**Admitting physician directly contacts Bed Control (x64010) for Ward Beds or Patient Flow (x65620) for Tele/PCU beds, clinic admissions get priority over ED admissions.
	**Scheduled Admission Office (x64412, x64416) open from 8:00 until 4:30pm to create FIN, stable patients go there while awaiting a bed.		**Scheduled Admission Office (x64412, x64416) open from 8:00 until 4:30pm to create FIN, stable patients go there while awaiting a bed.

Bchap23 at 16:17, 10 July 2025

2025-07-10T16:17:37Z

← Older revision		Revision as of 16:17, 10 July 2025
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	*Direct admissions during daytime business hours should be done OUTSIDE of the ED whenever possible		*Direct admissions during daytime business hours should be done OUTSIDE of the ED whenever possible
			** In general, a clinic can only direct admit to their own service (unlikely a patient in optho clinic can be directly admitted to neuro, but if the admitting service is aware of the patient, we can page them directly from triage for admission orders)
	** Clinic calls for stable patients requiring admission should be directed to an ED attending		** Clinic calls for stable patients requiring admission should be directed to an ED attending
	*** Ask: “Is the patient unstable? What immediate workup does the patient need in the ED that cannot be done once admitted?”		*** Ask: “Is the patient unstable? What immediate workup does the patient need in the ED that cannot be done once admitted?”

Bchap23 at 19:07, 30 May 2025

2025-05-30T19:07:21Z

← Older revision		Revision as of 19:07, 30 May 2025
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	*Direct admissions during daytime business hours should be done OUTSIDE of the ED whenever possible		*Direct admissions during daytime business hours should be done OUTSIDE of the ED whenever possible
	** ~~'''Physician Job Aid from Dr. Mendez''' 3-2025: [[File:DIRECT ADMIT FROM CLINIC.pdf\|thumb\|Direct Admit from~~ Clinic ~~Job Aid 3-2025]]~~		** Clinic calls for stable patients requiring admission should be directed to an ED attending
	** '''Have clinic resident talk to ~~their clinic~~ attending~~, clinic medical director, and clinic nurse manager if they don't know how to direct admit'''~~		*** Ask: “Is the patient unstable? What immediate workup does the patient need in the ED that cannot be done once admitted?”
	** Ask: “Is the patient unstable? What immediate workup does the patient need in the ED that cannot be done once admitted?”		**** Exceptions: emergent/urgent work up and stabilization, need immediate cardiac monitoring
	** Exceptions: emergent/urgent work up and stabilization, need immediate cardiac monitoring		** If it seems like the patients does not need the ED and should be a direct admission, '''escalate''':
			*** '''ED Attending to Clinic Attending'''
			**** '''Clinic Attending to Clinic Medical Director and Clinic Nursing Director'''
			***** '''ED AOD'''
			** Do not spend time trying to walk them through the process outlined below (it is only for reference). The Clinic Medical Directors should be able to walk their teams through the direct admission process.
			*** '''Clinic Physician Job Aid from Dr. Mendez''' 3-2025: [[File:DIRECT ADMIT FROM CLINIC.pdf\|thumb\|Direct Admit from Clinic Job Aid 3-2025]]

Bchap23 at 20:02, 9 April 2025

2025-04-09T20:02:48Z

← Older revision		Revision as of 20:02, 9 April 2025
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	*Direct admissions during daytime business hours should be done OUTSIDE of the ED whenever possible		*Direct admissions during daytime business hours should be done OUTSIDE of the ED whenever possible
	** '''Physician Job Aid from Dr. Mendez''' 3-2025: [[File:DIRECT ADMIT FROM CLINIC.pdf\|thumb\|Direct Admit from Clinic Job Aid 3-2025]]		** '''Physician Job Aid from Dr. Mendez''' 3-2025: [[File:DIRECT ADMIT FROM CLINIC.pdf\|thumb\|Direct Admit from Clinic Job Aid 3-2025]]
	** Have clinic resident talk to their ~~Nurse Manager~~ if they don't know how to direct admit		** '''Have clinic resident talk to their clinic attending, clinic medical director, and clinic nurse manager if they don't know how to direct admit'''
			** Ask: “Is the patient unstable? What immediate workup does the patient need in the ED that cannot be done once admitted?”
	** Exceptions: emergent/urgent work up and stabilization, need immediate cardiac monitoring		** Exceptions: emergent/urgent work up and stabilization, need immediate cardiac monitoring

Bchap23 at 13:36, 27 March 2025

2025-03-27T13:36:10Z

← Older revision		Revision as of 13:36, 27 March 2025
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	**Call UR (X65093/4/5) to get InterQual to meet		**Call UR (X65093/4/5) to get InterQual to meet
	**If no bed by 6:30pm, then the admitting physician will be contacted and their service should take the patient to the ED to wait until a bed is obtained.		**If no bed by 6:30pm, then the admitting physician will be contacted and their service should take the patient to the ED to wait until a bed is obtained.
	**Hold in the WR and place on the tracking board as a pre-arrival,		**'''Hold in the WR and place on the tracking board as a pre-arrival'''
	**Do not register in ED as they (already have orders)		**'''Do not register in ED as they (already have orders)'''
	** 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)		** '''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)'''

Bchap23 at 17:11, 16 March 2025

2025-03-16T17:11:34Z

← Older revision		Revision as of 17:11, 16 March 2025
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	*Direct admissions during daytime business hours should be done OUTSIDE of the ED whenever possible		*Direct admissions during daytime business hours should be done OUTSIDE of the ED whenever possible
	** Physician Job Aid from Dr. ~~Menzed~~ 3-2025: [[File:DIRECT ADMIT FROM CLINIC.pdf\|thumb\|Direct Admit from Clinic Job Aid 3-2025]]		** '''Physician Job Aid from Dr. Mendez''' 3-2025: [[File:DIRECT ADMIT FROM CLINIC.pdf\|thumb\|Direct Admit from Clinic Job Aid 3-2025]]
	** Have clinic resident talk to their Nurse Manager if they don't know how to direct admit		** Have clinic resident talk to their Nurse Manager if they don't know how to direct admit
	** Exceptions: emergent/urgent work up and stabilization, need immediate cardiac monitoring		** Exceptions: emergent/urgent work up and stabilization, need immediate cardiac monitoring

Bchap23 at 17:10, 16 March 2025

2025-03-16T17:10:48Z

← Older revision		Revision as of 17:10, 16 March 2025
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	*Direct admissions during daytime business hours should be done OUTSIDE of the ED whenever possible		*Direct admissions during daytime business hours should be done OUTSIDE of the ED whenever possible
	** [[File:DIRECT ADMIT FROM CLINIC.pdf\|thumb\|Direct Admit from Clinic Job Aid 3-2025]]		** Physician Job Aid from Dr. Menzed 3-2025: [[File:DIRECT ADMIT FROM CLINIC.pdf\|thumb\|Direct Admit from Clinic Job Aid 3-2025]]
	*~~Exceptions: '''need cardiac monitoring''', emergent/urgent work up and stabilization~~		** Have clinic resident talk to their Nurse Manager if they don't know how to direct admit
	*~~Tell~~ clinic to talk to their Nurse Manager if they don't know how to direct admit		** Exceptions: emergent/urgent work up and stabilization, need immediate cardiac monitoring


	*'''Business hours process: Any direct admissions before 8pm on Weekdays:'''		*'''Business hours process: Any direct admissions before 8pm on Weekdays:'''
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	Chappell 7/2017, updated 2/2025		Chappell 7/2017, updated 3/2025

Bchap23 at 17:07, 16 March 2025

2025-03-16T17:07:53Z

← Older revision		Revision as of 17:07, 16 March 2025
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	Direct admissions during daytime business hours should be done OUTSIDE of the ED whenever possible		*Direct admissions during daytime business hours should be done OUTSIDE of the ED whenever possible
			** [[File:DIRECT ADMIT FROM CLINIC.pdf\|thumb\|Direct Admit from Clinic Job Aid 3-2025]]
	*Exceptions: '''need cardiac monitoring''', emergent/urgent work up and stabilization		*Exceptions: '''need cardiac monitoring''', emergent/urgent work up and stabilization
	*Tell clinic to talk to their Nurse Manager if they don't know how to direct admit		*Tell clinic to talk to their Nurse Manager if they don't know how to direct admit