Harbor:Placement patients - Revision history

Bchap23 at 21:22, 17 March 2026

2026-03-17T21:22:29Z

← Older revision		Revision as of 21:22, 17 March 2026
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	* Once reviewed by the ED AOD for pathway appropriateness:		* Once reviewed by the ED AOD for pathway appropriateness:
	** '''From 7am - 4pm, care of the patient should be transferred to an inpatient team:'''		** '''From 7am - 4pm, care of the patient should be transferred to an inpatient team:'''
	*** '''Sunday, Monday, Wednesday, Saturday''' - call next admitting ~~team~~ on the template		*** '''Sunday, Monday, Wednesday, Saturday''' - call next admitting TEAM on the template (not the hospitalist)
	*** '''Tuesday, Thursday, Friday''' - call the hospitalist		*** '''Tuesday, Thursday, Friday''' - call the hospitalist
	*** DHS patients empaneled to '''Family Medicine (Lomita or Wilmington Clinics)''' will go to the FM service		*** DHS patients empaneled to '''Family Medicine (Lomita or Wilmington Clinics)''' will go to the FM service

Bchap23 at 17:05, 6 October 2025

2025-10-06T17:05:23Z

← Older revision		Revision as of 17:05, 6 October 2025
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	**** If during placement hours (7a-4p) and no response from AOD within 1 hour, please text or call (do not call overnight just to notify of the placement patient, just send the info via Teams):		**** If during placement hours (7a-4p) and no response from AOD within 1 hour, please text or call (do not call overnight just to notify of the placement patient, just send the info via Teams):
	*****'''Patient name, MRN#, ED Room #, Team (purple/green)'''		*****'''Patient name, MRN#, ED Room #, Team (purple/green)'''
	*****'''Brief clinical info''' (age, ~~comborbidities~~, how the patient arrived to ED [family, EMS, as a trauma])		*****'''Brief clinical info''' (age, comorbidities, how the patient arrived to ED [family, EMS, as a trauma], where pt came from [home, SNF, HL])
	*****'''Reason for need for placement''' (e.g. can’t do ADLs, dementia, abuse, etc.)		*****'''Reason for need for placement''' (e.g. can’t do ADLs, dementia, abuse, etc.)
	*****'''Skilled nursing needs? Wound care issues?'''		*****'''Skilled nursing needs? Wound care issues?'''

Bchap23 at 14:33, 24 September 2025

2025-09-24T14:33:53Z

← Older revision		Revision as of 14:33, 24 September 2025
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	** '''Place InterQual request'''		** '''Place InterQual request'''
	** '''Notify DEM AOD of "placement pending" patient as soon as identified'''		** '''Notify DEM AOD of "placement pending" patient as soon as identified'''
	*** <big>'''Provide the following information via TEAMS chat to the AOD; if no response within 1 hour, text or call the ~~AOD'''</big>~~:		*** <big>'''Provide the following information via TEAMS chat to the AOD'''</big>;
	****'''Patient name, MRN#, ED Room #, Team (purple/green)'''		**** If during placement hours (7a-4p) and no response from AOD within 1 hour, please text or call (do not call overnight just to notify of the placement patient, just send the info via Teams):
	****'''Brief clinical info''' (age, comborbidities, how the patient arrived to ED [family, EMS, as a trauma])		*****'''Patient name, MRN#, ED Room #, Team (purple/green)'''
	****'''Reason for need for placement''' (e.g. can’t do ADLs, dementia, abuse, etc.)		*****'''Brief clinical info''' (age, comborbidities, how the patient arrived to ED [family, EMS, as a trauma])
	****'''Skilled nursing needs? Wound care issues?'''		*****'''Reason for need for placement''' (e.g. can’t do ADLs, dementia, abuse, etc.)
	****'''PT/OT/SW/IQ all requested''' (and any status updates from these services)		*****'''Skilled nursing needs? Wound care issues?'''
	****'''Insurance information''' (from demographics tab: DHS empaneled vs OOP, specific type of primary insurance and secondary insurance)		*****'''PT/OT/SW/IQ all requested''' (and any status updates from these services)
			*****'''Insurance information''' (from demographics tab: DHS empaneled vs OOP, specific type of primary insurance and secondary insurance)
	**Ensure '''home meds''' are initiated if the patient will be in the ED for an extended time		**Ensure '''home meds''' are initiated if the patient will be in the ED for an extended time

Bchap23 at 23:54, 14 March 2025

2025-03-14T23:54:14Z

← Older revision		Revision as of 23:54, 14 March 2025
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	Effective 3/6/2023, revised 3/26/2025 per Dr. Goolsby (EM) and Dr. Thomas (IM) Chairs		* [https://s3.ap-southeast-2.amazonaws.com/wikem.cf.bucket/images/Placement_Pathway_March_2025.pdf Placement Pathway March 2025]
	~~[[File:Placement Pathway March 2025\|thumb]]~~		** Effective 3/6/2023, revised 3/26/2025 per Dr. Goolsby (EM) and Dr. Thomas (IM) Chairs

	* '''EM physician responsibilities:'''		* '''EM physician responsibilities:'''
	** '''Evaluate for any medically necessary admission needs''' (lab abnormalities, AKI, dehydration, UTI, delirium, pain mgt, wound care)		** '''Evaluate for any medically necessary admission needs''' (lab abnormalities, AKI, dehydration, UTI, delirium, pain mgt, wound care)
			** Help set patient and family expectations
			** '''Consult PT/OT''' ("Physical/Occupational Therapy Consult and Evaluation '''Inpatient'''" - no not use outpatient)
	** '''Consult SW'''		** '''Consult SW'''
	** '''Consult PT/OT''' ("Physical/Occupational Therapy Consult and Evaluation '''Inpatient'''" - no not use outpatient)		** '''Place InterQual request'''
	** '''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'''		** '''Notify DEM AOD of "placement pending" patient as soon as identified'''
	*** AOD ~~will confirm~~ patient ~~is appropriate~~ for ~~this pathway~~		*** <big>'''Provide the following information via TEAMS chat to the AOD; if no response within 1 hour, text or call the AOD'''</big>:
	**** ~~AOD will notify the UR/SW/Inpatient Directors~~		****'''Patient name, MRN#, ED Room #, Team (purple/green)'''
	** PT/OT/SW/~~UR must be consulted at~~ the ~~time of placement pathway, but they~~ will ~~likely~~ be in ~~various stages of completion~~		****'''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 any status updates from these services)
			****'''Insurance information''' (from demographics tab: DHS empaneled vs OOP, specific type of primary insurance and secondary insurance)
			**Ensure '''home meds''' are initiated if the patient will be in the ED for an extended time

	~~<big>TEAMS chat the following info to the AOD (if overnight, text at end of shift to confirm it was received)</big>:~~		* Once reviewed by the ED AOD for pathway appropriateness:
	*'''Patient name, MRN#, ED Room #, Team (purple/green)'''		** '''From 7am - 4pm, care of the patient should be transferred to an inpatient team:'''
	*~~'''Brief clinical info (age, comborbidities), how~~ the ~~patient arrived to~~ ED ~~(family, EMS, as a trauma)'''~~		*** '''Sunday, Monday, Wednesday, Saturday''' - call next admitting team on the template
	*'''Reason for ~~need for placement (e.g. can’t do ADLs, dementia, abuse, etc.)'''~~		*** '''Tuesday, Thursday, Friday''' - call the hospitalist
	*~~'''Skilled nursing needs? Wound care issues?'''~~		*** DHS patients empaneled to '''Family Medicine (Lomita or Wilmington Clinics)''' will go to the FM service
	*'''~~PT/OT/SW/IQ all requested and what stages we are in.'''~~		*** The ED should use the '''"Place in Observation"''' order, NOT Request for Admit
	*'''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
	<big>'''Remind the admitting team to NOT complete the "ADMIT to INPATIENT" order'''</big> on the multiple "admit" templates (this order creates the hospital admission icon which should not happen with these patients!)		<big>'''Remind the admitting team to NOT complete the "ADMIT to INPATIENT" order'''</big> on the multiple "admit" templates (this order creates the hospital admission icon which should not happen with these patients!)


	* ~~Fine Print~~		* Additional Notes:
	** ~~Maximum~~ of ~~'''one patient per day''' (if a second arrives~~, they will be ~~managed by the~~ ED ~~until 1pm~~ the ~~following day)~~		** PT/OT/SW/UR must be consulted at the time of placement pathway, but they will likely be in various stages of completion
	***Ensure '''home meds''' are ~~initiated if the patient will be in the ED~~ for ~~an extended time~~		** ED AOD will notify the UR/SW/Inpatient Directors via Teams chat
	** 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.		** ED assigned SW and UM support are responsible for post-discharge placement
	** ~~DEM AOD will track placement pending patients (MRN~~, ~~arrival date, discharge date, insurance, conversion~~ to ~~inpatient)~~		*** After 24 hours in ED bed on Placement Pending status, the patient will be admitted as Inpatient. UM staff will track duration of Placement Pending status and communicate with the care team.
			** If the Medicine/Family Medicine service identifies acute illness for which they desire inpatient admission, service should communicate with UM.
			** 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


	* Other Placement Patient Considerations:		* Other Placement Patient Considerations:
	**[[https://www.wikem.org/wiki/Harbor:Home_Health\| 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.		**[[https://www.wikem.org/wiki/Harbor:Home_Health\| Home Health]] – takes 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.		**'''SW options''': Housing for health, recup care, board and care, etc.
	**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.		*** 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.		*** 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.		**'''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.		*** '''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.		**Patient's that need '''outpatient HD''' chair, coordinate with the HD social worker as well (through SW consult)
	****ED PT/OT evals for placement are given priority given the urgent nature.		**'''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.
	****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==		==See Also==

Bchap23 at 23:27, 14 March 2025

2025-03-14T23:27:18Z

← Older revision		Revision as of 23:27, 14 March 2025
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	Effective 3/6/2023 per Dr. Goolsby (EM) and Dr. Thomas (IM) Chairs		Effective 3/6/2023, revised 3/26/2025 per Dr. Goolsby (EM) and Dr. Thomas (IM) Chairs
			[[File:Placement Pathway March 2025\|thumb]]

	* '''EM physician responsibilities:'''		* '''EM physician responsibilities:'''

Bchap23 at 21:33, 1 September 2024

2024-09-01T21:33:06Z

← Older revision		Revision as of 21:33, 1 September 2024
Line 11:		Line 11:
	*** AOD will confirm patient is appropriate for this pathway		*** AOD will confirm patient is appropriate for this pathway
	**** AOD will notify the UR/SW/Inpatient Directors		**** 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

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

Bchap23 at 16:21, 22 August 2024

2024-08-22T16:21:27Z

← Older revision		Revision as of 16:21, 22 August 2024
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	** '''Evaluate for any medically necessary admission needs''' (lab abnormalities, AKI, dehydration, UTI, delirium, pain mgt, wound care)		** '''Evaluate for any medically necessary admission needs''' (lab abnormalities, AKI, dehydration, UTI, delirium, pain mgt, wound care)
	** '''Consult SW'''		** '''Consult SW'''
	** '''Consult PT/OT'''		** '''Consult PT/OT''' ("Physical/Occupational Therapy Consult and Evaluation '''Inpatient'''" - no not use outpatient)
	** '''Place Interqual request and call UM'''		** '''Place Interqual request and call UM'''
	** Set patient and family expectations		** Set patient and family expectations

Bchap23 at 14:28, 6 July 2024

2024-07-06T14:28:28Z

← Older revision		Revision as of 14:28, 6 July 2024
Line 11:		Line 11:
	*** AOD will confirm patient is appropriate for this pathway		*** AOD will confirm patient is appropriate for this pathway
	**** AOD will notify the UR/SW/Inpatient Directors		**** AOD will notify the UR/SW/Inpatient Directors
	~~****~~ <big>TEAMS chat the following info to the AOD (if overnight, text at end of shift to confirm it was received)</big>:
	~~***~~'''Patient name, MRN#, ED Room #, Team (purple/green)'''		<big>TEAMS chat the following info to the AOD (if overnight, text at end of shift to confirm it was received)</big>:
	~~***~~'''Brief clinical info (age, comborbidities), how the patient arrived to ED (family, EMS, as a trauma)'''		*'''Patient name, MRN#, ED Room #, Team (purple/green)'''
	~~***~~'''Reason for need for placement (e.g. can’t do ADLs, dementia, abuse, etc.)'''		*'''Brief clinical info (age, comborbidities), how the patient arrived to ED (family, EMS, as a trauma)'''
	~~***~~'''Skilled nursing needs? Wound care issues?'''		*'''Reason for need for placement (e.g. can’t do ADLs, dementia, abuse, etc.)'''
	~~***~~'''PT/OT/SW/IQ all requested and what stages we are in.'''		*'''Skilled nursing needs? Wound care issues?'''
	~~***~~'''DHS eligible, empaneled, type of primary insurance and secondary insurance.'''		*'''PT/OT/SW/IQ all requested and what stages we are in.'''
	** At '''1–2pm, care of the patient should be transferred''' to an inpatient team:		*'''DHS eligible, empaneled, type of primary insurance and secondary insurance.'''
	*** '''Sunday, Monday, Wednesday, Saturday - call next admitting team on the template'''
	*** '''Tuesday, Thursday, Friday - call the hospitalist'''		* At '''1–2pm, care of the patient should be transferred''' to an inpatient team:
	*** DHS patients empaneled to '''Family Medicine''' will go to the FM service		** '''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		** The ED should use the '''"Place in Observation"''' order, NOT Request for Admit
	** <big>'''Remind the admitting team to NOT complete the "ADMIT to INPATIENT" order'''</big> on the multiple "admit" templates (this order creates the hospital admission icon which should not happen with these patients!)		<big>'''Remind the admitting team to NOT complete the "ADMIT to INPATIENT" order'''</big> on the multiple "admit" templates (this order creates the hospital admission icon which should not happen with these patients!)

Bchap23 at 14:26, 6 July 2024

2024-07-06T14:26:16Z

← Older revision		Revision as of 14:26, 6 July 2024
Line 11:		Line 11:
	*** AOD will confirm patient is appropriate for this pathway		*** AOD will confirm patient is appropriate for this pathway
	**** AOD will notify the UR/SW/Inpatient Directors		**** AOD will notify the UR/SW/Inpatient Directors
	**** ~~Please include~~:		**** <big>TEAMS chat the following info to the AOD (if overnight, text at end of shift to confirm it was received)</big>:
	*****'''Patient name, MRN#, ED Room #, Team (purple/green)'''		*****'''Patient name, MRN#, ED Room #, Team (purple/green)'''
	*****'''Brief clinical info (age, comborbidities), how the patient arrived to ED (family, EMS, as a trauma)'''		*****'''Brief clinical info (age, comborbidities), how the patient arrived to ED (family, EMS, as a trauma)'''

Bchap23 at 17:24, 20 November 2023

2023-11-20T17:24:48Z

← Older revision		Revision as of 17:24, 20 November 2023
Line 12:		Line 12:
	**** AOD will notify the UR/SW/Inpatient Directors		**** AOD will notify the UR/SW/Inpatient Directors
	**** Please include:		**** Please include:
	*****Patient name, MRN#, ED Room #, Team (purple/green)		*****'''Patient name, MRN#, ED Room #, Team (purple/green)'''
	*****Brief clinical info (age, comborbidities), how the patient arrived to ED (family, EMS, as a trauma)		*****'''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.)		*****'''Reason for need for placement (e.g. can’t do ADLs, dementia, abuse, etc.)'''
	*****Skilled nursing needs? Wound care issues?		*****'''Skilled nursing needs? Wound care issues?'''
	*****PT/OT/SW/IQ all requested and what stages we are in.		*****'''PT/OT/SW/IQ all requested and what stages we are in.'''
	*****DHS eligible, empaneled, type of primary insurance and secondary insurance.		*****'''DHS eligible, empaneled, type of primary insurance and secondary insurance.'''
	** At '''1–2pm, care of the patient should be transferred''' to an inpatient team:		** 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'''		*** '''Sunday, Monday, Wednesday, Saturday - call next admitting team on the template'''