I hate direct admits

[FireStarterRN, BSN, RN]

Why is it that when a doctor's office sends a patient to the hospital for a direct admit, that there is practically no information that they send? It seems like they just wash their hands of the patient and treat the hospital floor as an ER.

I got another direct admit the other day, the patient was hypotensive. Turns out that this elderly man just couldn't find his nitropatch to take off the previous day, didn't take it off, then put another one on. Don't office nurses do any assessments or investigations? Then, when I called the office to try and sort out the patient's med that they supposedly had with them, but somehow got misplaced by the family friend, and reported the fact that the patient's BP went up 20 points after I removed the second nitropatch, the office nurse snapped at me impatiently and was totally unhelpful.

I have some stories of other direct admits that demonstrate a similar breakdown in the continueum of care. Sometimes the only information we get is that there is a direct admit coming, the patient shows up, and we try to figure out why they are there, starting from scratch.

[Boston-RN, RN]

Sounds like my hospital LOL

[aeauooo]

Hey, some of those EMTs who bring direct admits to the unit are hot!

[Nursetastic]

I'm still in nursing school but managed a large medical office, most of the time when you call the office you do not speak to an RN or LPN but to an MA or CNA. Chances are high they were not familiar enough to do that type of assessment. Maybe asking to speak to the RN, if there is one, would help.

[FireStarterRN, BSN, RN]

I'm still in nursing school but managed a large medical office, most of the time when you call the office you do not speak to an RN or LPN but to an MA or CNA. Chances are high they were not familiar enough to do that type of assessment. Maybe asking to speak to the RN, if there is one, would help.

I did ask her is she was a nurse. She acidly replied that she was an RN, as if she was highly offended by the question.

[oramar]

I tell you the ER might have missed it also, they don't always have time to go over someone with a fine tooth comb. I had a patient that was worked up in ER then admitted for seizures. The patient was from a nursing home. When I started to do the assessment I realized that someone had made a mistake recopying the MAR and every day the patient was getting an extra dose of a certain medication. The medication built up slowly in blood until the heart slowed down to a point where the seizures occured. As soon as I saw it I knew what was going on but ER doesn't usually have time to go through MARs.

[YellowFinchFan]

direct admits can be very dangerous - no labs done , no xrays nothing.....just arrive on a busy floor where the nurse has many patients - MD orders slow to come in - we had a patient (direct admit) for what good reason I have no idea - I'm sure the 'inconvenience' of going through the ER would've been ok with the patient and family if they knew it could've saved their life. with no lab work - and a worrisome arrythmia - by the time we figured out what the 'problem' was we were in a code.

Direct admits shouldn't be allowed imho.

[plumrn, BSN, RN]

This is so maddening! They come directly from the doc's office. You would think that you would have all the orders you need either with the pt or being faxed to you shortly, including all home medications that the doc may want them on. Instead, the sick pt is trying to remember the names of their medications, there are no orders and the doc's office has already closed, etc., etc.

[TazziRN, RN]

In both facilities that I have worked at, direct admits had to come with orders either in hand or called ahead. No orders, no admit.

As for direct vs ER, why tie up an ER bed for a pt being admitted, unless no bed is available and the pt needs to be held? One thing ERs absolutely hate with a passion is a pt who arrives with orders to be done in the ER, then "admit to medsurg/ICU/wherever". If the doc already knows where the pt needs to go, then just send him there!!! To use the ER for convenience so the labs and everything get done faster is just plain wrong.

[TigerGalLE, BSN, RN]

Oh man I hate a direct admit. So much more paper work. I've even had a few that come without any orders! Once I had a patient that came with orders that said admit to floor, place HW, call when pt arrives.... Okay fine, but by the time the pt arrived a different doc was on call then the admitting. This doc knew nothing about the pt... HELLO? Wow it was a headache to say the least. Not something I want to deal with in the last hour of my shift.

I just hate directs. You never know how sick they really are.

Tiger

[miko014]

Our direct admits sound a lot like yours! I HATE that the come with no orders. I also hate that the pts have no idea what to expect. We've had them not know they had to stop at registration and sit in the room for an hour, then get mad and storm out to the station like "isn't anyone going to take care of me??" Well sure, if we had known you were here! Duh!

Also, we get a LOT of direct admits for blood. We're lucky if they get there by 5pm, and they need 2 units of blood, not to mention IV acces and a T+C before we can get the blood ready. Yet they expect to be home by 8pm! I'm sorry, but if your doc is sending you in for blood, they should tell you what to expect! Each unit takes 4-8 hours, plus the time it takes to get your labs drawn and get your units set up! That kills me, that really does. They either have never had blood before, or usually get it outpt, and don't realize that when they are in the hospital, it takes longer. And when you tell them that they might as well spend the night, they get mad! Hey man, if you wanna go home at 3am when your blood is done, more power to you. But you've paid for the room for 23 hours, you might as well sleep here and have breakfast before you go home!!!

That and the fact that sometimes they sit there taking up space for 4 hours before we get any orders just frustrates me to no end!!!!!

[Wendy_RN]

I have had direct admits that were "on their way" from the office adjacent to the hospital. Well, 6 hours later they decide to show up because they went home for a while, went out to dinner, smoked 3 packs of cigarettes before they came in because they knew they would not be able to do so on telemetry, etc. It is frustrating. When they finally show up there are no orders, some of them don't need to be there, and some of them needed treatment before they finally decided to show up. Direct admits are just a bad idea. There is a breakdown in communication and care is not delivered within the timeframe that it should be. Night nurses really appreciate report on a patient that was called as a direct admit at noon and the info is still incomplete. Just my opinion.