ED admitting orders

[bill4745]

How do other ED's obtain admission orders for patients?

In our ED, the ED doc discusses the patient with the admitting doc and then transfers the call to an RN to take admitting orders. This is a time-consuming, tedious, error-prone task. The admitting docs sometimes speak so rapidly that we can't keep up with them; sometimes they are on a cell phone and it can be difficult to hear them, especially with sound-alike drugs; we often don't have the patient's drug dosages (and sometimes no drug list at all) and they tell us to "write for whatever the family says he's on".

We are often told that verbal orders are to be taken "in an emergency only". Is taking verbal orders to admit a stable pt to med/surg an emergency? Obviously not. How do other hospitals deal with this issue?

[TrudyRN]

Maybe you can introduce your docs to the modern miracle of a FAX MACHINE.

[RoxanRN]

Here, the ER doc discusses the patient with the PCP and then writes orders for admission - usually "Admit to X floor. Call Dr. Attending for orders." Upon arrival to the floor/unit, it's up to the admitting RN to call the attending for the orders. Sometimes they will provide the basics and then come in hours later, or say they will be there shortly to see the patient and write orders. But sometimes, they do give us the entire order set and plan to see the patient in the morning (I'm a nightshifter).

[JBudd, MSN]

We have a group called the hospitalist team. Most of our private docs were quite pleased when the hospital put this program into play: they specialize in in house treatments, rotate their own shifts, cover each other and always have someone in house to see patients. The only time its a problem is on the night shift when we have 5 or 6 ER admits all waiting for the hospitalist to admit them, because there is only one on for nights. They talk with the private docs and specialists, but all the routine stuff is theirs.

[lyraesullivan]

Maybe you can introduce your docs to the modern miracle of a FAX MACHINE.

HAHA! Most of the docs I know haven't even mastered the telephone;)

[chip193]

How do other ED's obtain admission orders for patients?

In our ED, the ED doc discusses the patient with the admitting doc and then transfers the call to an RN to take admitting orders. This is a time-consuming, tedious, error-prone task. The admitting docs sometimes speak so rapidly that we can't keep up with them; sometimes they are on a cell phone and it can be difficult to hear them, especially with sound-alike drugs; we often don't have the patient's drug dosages (and sometimes no drug list at all) and they tell us to "write for whatever the family says he's on".

We are often told that verbal orders are to be taken "in an emergency only". Is taking verbal orders to admit a stable pt to med/surg an emergency? Obviously not. How do other hospitals deal with this issue?

Hospital #1 - my full-time job - 350 bed hospital with teaching programs in Medicine, Surgery, Dentistry, and Pathology.

We do NOT take admission orders at all. The admitting residents see all Surgery and most Medicine admits. The patients who are not seen by the residents (uncovered) have "holding orders" written by the ER attending which moved the patient upstairs. The community attending then calls the floor with the orders. Holding orders are also used when the admitting residents are backed up and we need beds.

Hospital #2 - my vacation club job - 120 bed hospital with teaching program in Podiatry (no, I'm not kidding)

Admission orders are taken by the ER nurse when the community attending calls.

Alas, I prefer #1. And, if you think about it, does it not make more sense for the nurse who will care for the patient on the floor who can then ask questions to clarify orders?

[ernurse61]

Our ER Doc talks to the admitting MD then we take the admit orders. Often times we hold pts in ER. When this happens not only do we carry out the admit orders, but we have to do the admit summary.

[WahooRN08]

At my facility, the ED physican has a few options depending on the admitting physician and the hour of the night.

#1 Will write the basic orders, and write Call Dr. Jones for further orders. (Which is a bi*ch at 0300)

#2 Write all the orders him/herself and admit to the physican.

#3 The most common thing, the admitting physican will come in regardless of the time, especially in specialty areas. Anymore most of our admissions are hospitalist based, IM and Family practice. And the specialist are consulted out.

Good Luck, this first process would be awful.

A

[Email4KH]

This is a pet peeve for me.

Our ED docs call admitting docs who then either come in and write or call in orders.

Calling in orders isn't bad from the RN standpoint, but the ones who come in and then take over an hour to write floor orders create an unnecessary delay.

I've been pushing for a policy that would have the admitting docs write very basic admitting orders such as: Admit to medical bed. Diagnosis Y. Continue IV at xml/hr. FLOOR ORDERS TO FOLLOW.

Then, they should go up to the floor and take as long as they please to write the specific orders to be administered on the floor. Stop tying up ED rooms for this crap.

[rentalnurse, RN]

Ive had all of the above since im a traveler,, hate taking phone orders (usually get a foreign doc that barely speaks english) hospitalist is nice and usually can clarify orders with them since they stay in the hosp, where i am now is a gov IHS facility and the md on call comes in no matter what time to see the patient and to write orders,, when i wk in the unit certain ones will stop by after the patient is in the unit and see if there are any problems. one hospital i was at i was waiting for orders in the er and the charge nurse came over to ask why the pt was still in the er and i told her i had no orders and she said we take them up when they have a room and orders are done on the floor,, that was a new one...