Admissions Unit

[MunoRN, RN]

Does anybody out there use an "Admission Unit"? Ours is a unit where patients go between the ER and their admitting floor. For the most part, this is only for floor patients although we've been getting quite a few step down and ICU patients that have gone through this unit. Basically, it's where patients go to get their admission history and medications documented so that the admission nurses don't have to go to the floors or the ER to do it. (I think it's also so we can code the patient as an inpatient sooner).

Ours doesn't really seem to be a patient care unit, just a paperwork unit, so we've have some patients who spend hours there without anything being done, even as their labs and tests result that show things that need to be addressed (DKA for instance). I had a patient whose BG was 800 in the ED and labs (at 0900) showed DKA, yet the patient didn't get an insulin gtt started until 1700 because they were sent to the admissions unit before their labs even resulted and the admissions unit doesn't do gtt's. Is this the new thing?

[JDZ344]

We have these in the UK. Never worked there, but when the wards get patients from there its better because more things are done than if they come from A&E, it really saves lots of time.

[chocolateheals]

Hmm. Maybe I missed the point of the "admission unit." Are the patients physically moved from the ED to you, then to the floor or ICU? The hospital I work at has an ED, but patients who are admitted go directly to floor/ICU. We do have something called "ED observation" which is opened if the ED is especially busy. Patients go here if: 1. The ED is full, and they are not sure if the patient will be admitted at all, so some additional workup/ observation is done there. Or 2. If the ED is full, and there are no acute care or ICU beds open.

I will say that there is some delay in our admit labs and treatment if the floor is busy... but a new patient will obviously get priority over someone present and stable. But, it sounds like th is is happening in your admit floor too. Interesting. I'd love all the hx and paperwork to be done by the time they get to me, though!

[wooh, BSN, RN]

We have an admissions unit, and they are awesome. Most of the nurses used to do float pool, so they know what it's like on the floor. And they know if they get a patient that shouldn't come to the floor, and they'll get them sent to ICU instead. They do the paperwork, get IVs started, get a start on orders... Basically, it's a great group that do all they can to make it easier on the floor nurse. LOVE them. And if they aren't busy, they'll even come to the floor, or go to PACU to do the admit paperwork for surgical admissions. It's a great idea if it's staffed with the right people.

[Anna Flaxis, BSN, RN]

Sounds like a great idea if treatment would actually get started in such a unit. I would imagine it would help the ED turn over beds faster, and the patient to feel like their care was progressing, rather than being "stuck" in the ED for the entire time.

[Silverdragon102, BSN]

I worked for several years in a medical admission unit in the UK and loved it. Yes it was very busy and we accepted all medical admissions to the hospital from A&E/ER, outpatient clinics and the community. We did all admission paperwork and started any investigations/treatments. Sometimes the patients went home from the unit other times they would be admitted. Average stay on the unit was 24/48 hours although if required admission to the hospital they was moved sooner rather than later

[ZippyGBR, BSN, RN]

Hmm. Maybe I missed the point of the "admission unit." Are the patients physically moved from the ED to you, then to the floor or ICU? The hospital I work at has an ED, but patients who are admitted go directly to floor/ICU. We do have something called "ED observation" which is opened if the ED is especially busy. Patients go here if: 1. The ED is full, and they are not sure if the patient will be admitted at all, so some additional workup/ observation is done there. Or 2. If the ED is full, and there are no acute care or ICU beds open.

I will say that there is some delay in our admit labs and treatment if the floor is busy... but a new patient will obviously get priority over someone present and stable. But, it sounds like th is is happening in your admit floor too. Interesting. I'd love all the hx and paperwork to be done by the time they get to me, though!

the UK experience with admissions / assessment Units comes from 2 main factors

1. the culture of direct admissions in the UK where Family Doctors see patients at home or in the Surgery and then arrange admission directly to the relevant Speciality - historically this meant new admissions would be scattered across the site sometimes into any random bed if occupancy was high

2. the introduction of the (politically motivated) 4 hour target for the Emergency Department - which had as one of the few clinically significant benefits the needs to virtually eliminate ED holds

if the Admissions / Assessment unit is run well it can be a real bonus , staffed with Nurses who have the skills and ability to intervene of the ED nurse plus the ability to do things that there aren't time for in the ED - if they aren't run welll it can be a killing field

[worked hard and long]

Looks like your admissions unit needs better leadership, and reorganization. Pts should never go to admitting unit then to ICU. How then does a person meet the criteria for an ICU bed. 1 -2 nurses from the admitting unit should be free to go from unit to unit helping those admissions who SHOULD NOT go to the admitting unit. IE ICU/CCU or pt needing traction on ortho floors who should not be moved unecessarily. staff should go to the ED to start paperwork. When not admiting pts those nurses can help floor nurses with IV starts and drsg changes. Everybody is happy, OT cost are lower, staff goes home to family.