doctors using to ER to adment ?

Ruby Vee, BSN · Jul 15, 2011

why do some doctors have to send people to the er to be addmented to the hospital? this makes no sence to me at all if the doctor thinks you need to go into the hospital why can they not just put you in ? what am i missing this seems like the dumbest thing ever .

addmented?

MunoRN, RN · Jul 15, 2011

I think you mean admit, the policy where I work is that patients can only be directly admitted to the ICU, L&D, and planned surgical patients. We tried allowed direct admits to our cardiac floor for a while but too often we'd have a patient in a room for hours with no orders, which can be a problem if the patient is unstable and nobody will give you orders because none of the Docs with hospital privileges has seen the patient. Cardiologists with hospital privileges can direct admit but only if we have orders when the patient arrives, otherwise they go down to the ED. By sending direct admits through the ED, it ensures patients will be seen my an MD within a reasonable amount of time, and that any urgent issues can be dealt with without waiting hours.

Trekfan · Jul 15, 2011

addmented?

google is not helping me i am looking for the word that means "to be put in to the hospital" ?

Trekfan · Jul 15, 2011

I think you mean admit, the policy where I work is that patients can only be directly admitted to the ICU, L&D, and planned surgical patients. We tried allowed direct admits to our cardiac floor for a while but too often we'd have a patient in a room for hours with no orders, which can be a problem if the patient is unstable and nobody will give you orders because none of the Docs with hospital privileges has seen the patient. Cardiologists with hospital privileges can direct admit but only if we have orders when the patient arrives, otherwise they go down to the ED. By sending direct admits through the ED, it ensures patients will be seen my an MD within a reasonable amount of time, and that any urgent issues can be dealt with without waiting hours.

Thank you for the help I was not able to change the title though . But that just seems like a nightmare for the ER and the person that is stuck waiting for hours to be seen ?

gentlegiver, ASN, LPN, RN · Jul 15, 2011

The word you are looking for is "admitted", google & spell check are not always reliable.

Trekfan · Jul 15, 2011

The word you are looking for is "admitted", google & spell check are not always reliable.

thank you :)

eriksoln, BSN, RN · Jul 15, 2011

Thats what I thought too, "admit".

Besides the problems already mentioned, direct admits present a number of problems that just are not worth inviting in your door when going through the ER is available.

1. Many people who are told to go to the hospital by the doctor take their time and lose track of the ultimate goal. They go home, make sure the dog is fed, collect lots of stuff to do while in the hospital etc etc..........

If it stopped there, it'd be fine. But they keep finding things to do: Send out that bill they forgot, write a letter to w/e relative, take perishable groceries to the neighbor, go have a nice meal with a few friends, catch the episode of "Deal or No Deal" before heading out, stop at the local bookstore for a few magazines........the list is endless. These are all real examples of things people told me they had to do before they came in.

So, what you have is a boatload of patients showing up between 9PM and 11PM who were supposed to be there Between noon and 3PM. Staffing is different at those hours, so the whole admit process is now a PIA instead of being routine. Some orders written by the physician (if there are any) are timed to happen that night (X-ray tonight) and now are almost impossible to complete on time.

2. Somewhat related to #1: When the hospital is informed someone is going to be admitted directly, a bed is held for them. Imagine someone going through all the "must do" motions described above then realizing.......it is almost midnight. They call, inform the hospital they are coming in the AM and think nothing of it. Meanwhile, an ED patient could have been in that bed hours ago.

3. Sometimes, while out gallivanting around, people realize they don't want to be hospitalized and change their mind. This is their right, but refer to #2.

These are all RL examples of issues presented to the hospital by direct admits, AND you have the ones arriving with no orders sitting there for hours without being seen to boot.

Directly admitting patients presents no advantage great enough to justify dealing with these issues.

P_RN, ADN, RN · Jul 15, 2011

In my location all the hospitals have hospitalists. The "regular doctor" makes contact with the hospitalist who then follows the patient while in the hospital. These hospitalists do not have their own practice but they do have ancillary staff such as NPs and PAs to assist. If consults are needed the hospitalist calls the regular doctor and they decide on who to call who then reports to the hospitalist.

Regular doctor rounds are quite different now. And it seems the stay in hospital are shorter but much more satisfying.

Emergency RN · Jul 15, 2011

Why do some doctors have to send people to the ER to be admitted to the hospital? this makes NO sence to me at all if the doctor thinks you need to go into the hospital WHY can they not just put you in ? What am I missing this seems like the dumbest thing ever .

Are you missing something? Is this the dumbest thing ever?

Debatable.

Often, doctors will admit through the emergency department (we're no longer just a "room") for certain procedures because some insurance companies will otherwise not pay unless it was considered "necessitated by medical emergency." Otherwise, patients may have to pay out of pocket if the insurance underwriter denies a claim. Additionally, in the ED, a patient's work up is actually much faster in that labs and needed diagnostics are performed within several hours. A typical patient will get blood work, EKG, Xrays, CTs and SONO; all at one shot (on a good day, in two hours or so). If a patient was admitted to a floor first, then each of those things would have to be individually scheduled against a sea of other waiting hospital patients. Just the transport queue of one may prevent the patient from getting more than one or two tests a day. So, docs that want their patient results quickly may attempt to do an end run around the system by using the ED.

Nccity2002, MSN, RN · Jul 15, 2011

why do some doctors have to send people to the er to be admitted to the hospital? this makes no sence to me at all if the doctor thinks you need to go into the hospital why can they not just put you in ? what am i missing this seems like the dumbest thing ever .

not at all. because of emtala regulations, hospitals can't turn away patients presenting to the er who require emergent care, regarless of insurance, legal status, or any other excuses hospitals used in the past, to deny medical care. many times it is faster to take care of a patient's needs ( a ct or any other dx treatment) if the patient comes via the er, rather than if the patient comes as a direct admit....case in point, we all had heard horror stories about kaiser patients...(at least here in ca).

" the emergency medical treatment and active labor act (emtala) is a u.s. act of congress passed in 1986 as part of the consolidated omnibus budget reconciliation act (cobra). it requires hospitalss and ambulance services to provide care to anyone needing emergency healthcaree treatment regardless of citizenshipp, legal status or ability to pay. there are no reimbursement provisions. as a result of the act, patients needing emergency treatment can be discharged only under their own informed consent or when their condition requires transfer to a hospital better equipped to administer the treatment (aaem,2011)."

american academy of emergency medicine, (2011). emtala: introduction. retrieved june 15, 2011 from

http://www.aaem.org/emtala/watch.php

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Altra, BSN, RN · Jul 15, 2011

Huge issue where I have worked. And while it's probably not "the dumbest thing ever" ... it's on my top 10 list.

Patient goes to PCP with XYZ symptom(s). PCP decides to admit, but is too lazy to actually write some orders & have office staff call hospital admissions. PCP tells patient, "just go to the ER, they'll *get you admitted*." This is patient's expectation, because that's what they've been told.

However, what actually occurs is this:

Patient arrives to ER, and just like every other patient they are seen in order of priority of whatever else is presenting to the ER at that time. Diagnostic workup is completed to arrive at an admitting diagnosis. Then, and only then, is the admission process started.

Just my opinion, but it's BS. How hard is it for the PCP to write some standard orders and get a bed requested? I despise this practice. When patients & families complain (rightfully so) because it's now been 12 hours since they were "told to go to the hospital" and they're still in the ER ... I educate them -- that their PCP had the option to directly admit them, and that if this happens again, they are well within their rights to discuss this with their PCP.