Direct Admits

majrn · Jan 2, 2003

My facility does allow direct admits but they are usually , obviously, non life treatening things(not requiring immediate attention.) Stuff like cellulitis, wound infections, oncology with counts out of whack etc. Not sure what policies actually say about direct admits. Probably something I should know. Admits do make a stop at admitting first then go to the floor.

AHarri66, BSN, RN · Jan 2, 2003

Our hospital allows direct admits with no trip thru the ER, or even admitting, for that matter. We're trying to change that, however. We have recently been piloting a program that utilizes an Admitting Nurse, who performs initial assessments, initiates a care plan, and (hopefully) gets the ball rolling as far as IV starts, labs, and other admission testing before the patient hits the floor. We don't have an IV team, and have floor-based techs who do phlebotomy and EKGs. Our tech leaves at 1 pm, so after that those responsibilities fall to the nurses. The program seemed to help quite a bit during the month or so it was piloted, especially for the late afternoons. I hope they decide to continue the practice.

SmilingBluEyes · Jan 2, 2003

In OB we are exceptional in that ALL our patients are DIRECT admits really. Not a med-surg nurse, so I dont' know what is done there.

hapeewendy · Jan 2, 2003

we take the occasional direct admit

but since the whole fiasco that took place on my unit last year , I think all the patients who were to be direct admits are at least assessed in ER before transfer

last years "situation" involved a patient being transferred to toronto , dying, to be closer to her family or whatever , which is honorable and nice and we knew something else must have been going on, so ER calls and says "ok ur direct admit is here, we didnt do anything for her , and she came with no orders, and she needs a bath cuz she smells" uhhhhhhhh wtf?!??!

so i hear the elevator on its way up and I see 2 paramedics BAGGING this patient...this patient who was supposed to be DNR! I was like okay wtf is goin on now , the family says "oh we got her brought here for the best care in the city, they werent doing anything for her in her small town,so now that we are here we want everything done"

needless to say everyone involved was peeved, there was incident reports filled out the wazoo and I'm positive it went to management...

totally inappropriate !

hopefully policy was changed but I'm not really sure cuz I havent had a direct admit in a long time...

Tweety, BSN, RN · Jan 2, 2003

Most of our direct admits come from another facility by ambulance transport, usually to take advantage of our trauma services. We usually know they are coming and it's not a big deal, except that a lot of times they don't have orders and we don't get a report.

Other admits say from a doctors office, usually have to go to the ER for a workup before coming up to the floor.

We also do a lot of direct admits for our continuous video eeg monitoring.

defib queen · Jan 2, 2003

As an er nurse, I would have to ask, why would you want all direct admits to be worked up in er first? In our er, if we worked up all the direct admits before they were admitted, we would not have time or space to take care of the emegency patients. We have a real problem with our patient ratio being at least 50% or greater being non-urgent problems i.e. cold symptoms for 4 days, etc. things that could have waited for the doctors office to open or be taked care of with otc meds. This takes precious time away from urgent and emergent patients and a toll on the staff at our facility.

I really don't have a problem with a patient being a direct admit if they have seen their pcp. I worked on a busy med-surg floor for 3 years, when I got a direct admit report came from patient assessment, just as in the er with walk-in patients we don't get a report from someone, we get report from patient history and assessment.

mattsmom81 · Jan 2, 2003

I remember direct admits on PCU and medsurg and it was always problematic. We had to drop everything and become a mini ER and it totally disrupted the unit's routines and caused excess stress for everyone. And it's not best for the patient in most cases. The ER is the best place to run an ER cuz they're set up for that...with a doc right there to see the patient.

Why is it that some doctors still insist on this practice? Is it a vendetta against the ER docs, ya think? (I've suspected this with some of my docs...an ego wrestling contest with the ER doc)

Love the idea of a policy against them...it is in the facility's interest too to stop this practice, IMO.

Trauma Columnist · Jan 2, 2003

I work large teaching hospital, level one trauma center and we have a lot of direct admits - thank goodness. People coming from MD's office - nonemergent admits - ABSOLUTELY NO reason to be seen in ER. We are so overwhelmed it is unbelievable. We account for 40% of hospital admissions as it is.

Nurse Ratched, RN · Jan 2, 2003

Our ward allows direct admits - usually it's a doc-to-doc thing where a person is sitting in an outpatient psych setting clearly in need of inpt tx. It increases the chance of the person getting the help they need if we can bring them right in.

My objection comes when our frequent flier addicts come knocking on the unit door at 9am drunk or high and know that if our regular doc is in, he'll open the door and write orders right then. These admissions happen on cold, rainy days and the person has no desire to get clean that day; he is just looking for 3 hots and a cot. Tremendous waste of resources, imho. Technically, either way it shouldn't make a huge difference - the admission criteria should be the same whether the person is presenting in the ED or as a direct admit. But I have seen that docs in the ED tend to weed out a little better.

jemb · Jan 2, 2003

When I worked inpatient --not that long ago-- we did get direct admits on the floor. They did have to stop at admitting for paperwork.

The hospital's policy, or lack thereof, regarding direct admits, or even admits from ER, for that mattter, created a lot of problems for the nursing staff. The only order required for the patient to be admitted was "Admit to service of Dr. Whoever." Patients would arrive in pain, hungry, vomiting, pooping, gasping, wheezing, with family in tow. If they came from ER, we had a diagnosis. If they were direct admits, we usually had nothing! We had to call or page the docs for orders, and sometimes didn't get orders for a couple of hours. I remember one time that it took the doc over six hours to respond! In the meantime, the poor patient was not being treated, and the family was going ballistic. Patients and families understandably found the statement, "I'm sorry, but I can't feed you, give you pain med, or anything else until I hear from your doctor. Yes, I'm just waiting for him/her to return my call(s)." This was especially disturbing when the patient came directly from the doctor's office, and could have hand-carried the orders with them!

I don't miss that place!

zudy · Jan 2, 2003

I am also in a large teaching hospital, so we get quite a few direst admits. We also account for app 35-40% of admits. I use to work in a private hospital in the ER where the outside drs would let their private pts come in to ER," Just for some pain meds, IV, Lab x-ray, etc. so they don't have to sit around in the admitting office" There was a policy against it, but natch, it was not enforced, for fear of UPSETTING THE DOCTORS!!!!! :eek: Who cares that our emergency pts had to wait?