Admitting Patients from the ED

Specialties Emergency

Published

I have a question. What is your admission process for timely admits to the floor. Our current process: Take orders over the phone or wait for the doctor to come in and write them themselves. Call supervisor with admit orders. Charge nurse from floor calls with bed number and who to call report to. Send for a tele if needed. Try to call nurse on floor with report......... Get tele. Have admissions do admit paperwork. Get tech to take patient to the floor. This takes forever!!!!!!!!!!

What is your process and how long does it usually take?

Thank you in advance!

Up Vote Up Vote ×
Specializes in ER/Trauma.

Our process:

Once ED doc decides pt. needs to be admitted, he has secretary call/page the attending service (Hospitalist or XYZ Physician group). At the same time, he also informs secretary of what kind of bed he needs for pt. - in patient or observaion? Ortho, Stroke Unit, ICU, Behavioral Health, Tele, Med Surg, Remote Tele etc.

Secretary calls House Supervisor (or Flow Co-ordinator) with bed request. They liaison with the charge nurses on the floors, the units etc.

Attending Doc calls back, discusses case with ED doc. After this, either ED doc takes orders from attending Doc or has an ED nurse take orders. If it's the in-house hospitalists, they come down, assess pt. and write their own orders.

Beds are not assigned until room is ready/cleaned and a nurse has been assigned to take pt. Co-odinator calls secretary with bed assignment. Secretary updates info on ED main screen.

Once ED has BOTH admission orders and a bed (each can happen before the other), report is called.

Sometimes, if it's a very straight-forward case (especially if the Hospitalist is involved); as soon as I have a bed, I'll call report.

[except ICU] If no-one is available to take report, the chart is faxed and 15 minutes later, pt. is taken to floor.

cheers,

Up Vote Up Vote ×
Specializes in Hospital Education Coordinator.

our process is similar to the one Roy Fokker describes. However, we have a form (one of thousands!) that constitutes a report from the ED nurse. It is faxed to the receiving unit. This allows all concerned to have enough info to get started. It does not take the place of both nurses communicating with each other, but does seem to shave a little time off time in the ED.

Up Vote Up Vote ×
Specializes in ICU.

most of our ED admits come at change of shifts...hmmmm wonder why that is??? reports from them are usually worthles (according to the ED managers, their nurses "are not allowed" to assess patients, it upsets the ED docs??!......still trying to figure that one out) if the patient is really bad, the doc will call us with a heads up.....if the patient is really really unstable you can bet they'll be up in the ICU in a flash! sorry but the admission process at my hospital is a joke. :D

Up Vote Up Vote ×
Specializes in Emergency/Trauma/Critical Care Nursing.
most of our ED admits come at change of shifts...hmmmm wonder why that is??? reports from them are usually worthles (according to the ED managers, their nurses "are not allowed" to assess patients, it upsets the ED docs??!......still trying to figure that one out) if the patient is really bad, the doc will call us with a heads up.....if the patient is really really unstable you can bet they'll be up in the ICU in a flash! sorry but the admission process at my hospital is a joke. :D

wow, sure glad I don't work at your hospital... our ED's process is pretty short and sweet, at least on my end of things, the doc decides he wants someone admitted and puts the bed request order for the type of bed needed (gpu/cardiac/icu etc) on our emstat program which activates the "atmo admission" process that i couldn't tell you how it works. once they find an open bed we get a little print up order receipt that says bed ready room bla bla, and the order for the bed request clicks off, then we have our order for nurse report call come up that when we click on it its a report form of all important data that we print out along w/our ED handoff sheet (a printout of EVERYTHING charted on emstat about the pt) that we fax to the unit then give to the secretary who requests transport to come get them. the only time anything is different is if the pt needs to go to ICU/emergency surgery etc then we call the receiving nurse ourselves to give report and then transport the pt ourselves on a monitor and then answer any other questions the nurse may have upon arrival. the way i wrote it seems longwinded but if theres plenty of beds available the process is very quick, if not, ur just stuck waiting until theres an open bed.

p.s. in my ED we ALL assess our pts regardless of what the Dr. may think, i haven't come across one yet that hasn't appreciated input from a nursing assessment that they may have missed. and generally the ICU nurses that we call report to are very appreciative of our reports, they can get valuable info on a pt who we may have been able to talk to at some point that they are now receiving unconscious and can't ask questions. and we never PLAN to admit pts at shift change, we admit them when the bed is available..

Up Vote Up Vote ×
Specializes in ED.

Ugh. Our process sucks.

Pt. presents to ED. ERP runs tests, etc., decides to admit. Put out page to on call doc. Wait for return call. Then wait for admit doc to come to ED and write admit orders (can honestly take up to 10 hours to get these orders).

Now we have admit orders. Place order in computer for bed upstairs.

Now....wait. And wait. Start implementing admit orders in ED. And wait.

When the floor in question has a bed, they notify bed control. Bed control tells us we have a bed (we can wait anywhere from 2 minutes to 36 hours for a bed).

Fill out fax report. Fax to the floor. Call to see if fax got there. Get told it didn't go through/was sent to wrong fax machine/room not clean/no bed in room/etc/etc.

Call transport once cleared to send patient. Wait. Wait. Finally send patient. Or escort them if tele patient.

We hold so many patients in the ED. Many nights I am a floor nurse...and I am so not a floor nurse. Our process is slow and inefficient. Sometimes ER docs write holding orders so we can get patients upstairs faster. I love this. They should all write holding orders.

Up Vote Up Vote ×
Specializes in ER, tele, vascular.
Our process:

Once ED doc decides pt. needs to be admitted, he has secretary call/page the attending service (Hospitalist or XYZ Physician group). At the same time, he also informs secretary of what kind of bed he needs for pt. - in patient or observaion? Ortho, Stroke Unit, ICU, Behavioral Health, Tele, Med Surg, Remote Tele etc.

Secretary calls House Supervisor (or Flow Co-ordinator) with bed request. They liaison with the charge nurses on the floors, the units etc.

Attending Doc calls back, discusses case with ED doc. After this, either ED doc takes orders from attending Doc or has an ED nurse take orders. If it's the in-house hospitalists, they come down, assess pt. and write their own orders.

Beds are not assigned until room is ready/cleaned and a nurse has been assigned to take pt. Co-odinator calls secretary with bed assignment. Secretary updates info on ED main screen.

Once ED has BOTH admission orders and a bed (each can happen before the other), report is called.

Sometimes, if it's a very straight-forward case (especially if the Hospitalist is involved); as soon as I have a bed, I'll call report.

[except ICU] If no-one is available to take report, the chart is faxed and 15 minutes later, pt. is taken to floor.

cheers,

Our process is very similar to what was described above. Only bad thing is we end up holding a lot of pts, because of a lack of beds on the floors.

Cam

Up Vote Up Vote ×
+ Add a Comment