Direct Admits

[MissdonditaBsn]

I am just curious..............................

Do your facilities allow patients to be admitted as a Direct Admit, meaning they are admitted Directly from the Doctor's office or even sometimes from home, no trip through ER?

If you do allow them, what sort of policies are in place for these admits? Are there certain diagnosis not are not allowed to be admitted Directly? Do they go to Admitting first and then the floor, or do they go directly to the floor?

Any input you could give me on this subject would be greatly appreciated.

Thanks,

Donna

[nimbex, RN]

Our CCU does get direct admits, many that would not need to be "inconvienenced by the crowded ER". Usually works well, call the MD for orders and the cardiologist comes in....

We DO get the "I'm having chest pain, pressure is in the 70's, HR 130's, and you are placed in a legal nightmare.... pressure is falling, needs an IV, EKG, labs..... and it can take 15-30 minutes to get a doc on the phone.......

very..... very bad for ALL involved, mind you all of them come from the MD's office..... WHY not send orders with them???

feel your frustration

[altomga, ADN, BSN, MSN, DNP, RN, APRN]

:imbar oh we get plenty of direct admits to my step down ICU floor; either it be from an outside facility, doctors office, or even an outpatient dialysis unit. I actually prefer the admits that are brought in by our ambulance crews; they are usually pretty good about redirecting the patient to the ED if they are totally inappropiate for my floor or getting the admit changed to the ICU; and they always call us to let us know their ETA. Most of the time though if the other hospital is sending via their ambulance the pt could be 5min from arriving when the nurse calls to give report and plenty of times we still haven't opened up a bed for the pt! This really ticks me OFF!!! Discharge summaries?...yea right; sometimes get them, sometimes not. I have a pretty good rapport with the private physicians that usually do direct admits and they give me orders over the phone until they get there to see the pt, and if the pt doesn't belong on our floor they usually trust my opinion thank heavens! I don't mind direct admits at least I know where to start at; Our ED is not the greatest about doing orders that were to be done in the ED and that makes us have to play catch up a lot. Any hoo...all in all doesn't make a stink to me; my floor is always getting a pt from somewhere!

[ratchit]

I worked med/surg many moons ago and ICU far more recently. Got direct admits in both places. Sometimes it was OK, sometimes it was a dangerous fiasco.

If someone is sick enough to be admitted to the hospital, they should be seen by a doctor before they get to the floor. If they are sick and go to the doc's office, I have no problem with him sending them over as a direct admit without a trip to the ER. IF and ONLY IF he sends orders with the patient. (Or faxes them, whatever.) You can't have an inpatient with no MD orders or assessment, period. Too much liability for the nurse and more importantly, too risky for the patient. (If they are stable enough to wait 8 hours for treatment until the doc comes in, they could have done that at home or in the office.)

No patient should be an inpatient without being seen by a doc to make sure that a) what the patient SAYS is wrong is really the problem and that b) the patient is placed in the appropriate unit.

If the docs are sending patients from their offices to the floors without orders, that's something for the floor manager to address with the doc. If the patient is sent from home to the hospital without ever seeing a doc, then they should go to the ER to be seen to protect the patient and the nurse. If the ER docs feel they are being abused, let them take it up with the PCP's.

There will be occasional exceptions that might be OK- cancer pain management, an obvious exacerbation of a known chronic condition with a known treatment... But in general, I think we shouldn't accept patients into beds until they are seen by someone.