I hate direct admits

Nurses General Nursing

Published

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.

Specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.

I was waiting and waiting for a direct admit a while back and finally decided I would call her own house (by this point it was after office hours). I woke her up. She had gone home from the doctor's office, apparently unimpressed by her K+ of 7 and had gone to bed. Trying to convince her to come to the hospital was a feat in itself. Then I had to page the on-call doc to let him know what was going on. Just ridiculous.

A direct admit should be just that. Send orders, old records, and med lists and ensure that the patient is going DIRECTLY to the hospital. Do not pass go. Do not collect $200. I think if the doctor's office feels like the patient is going to go home and goof off for a couple of hours they should just call the EMTs to pick them up and take them through the ER. It is just nonsense when a "direct admit" doesn't show up to the floor for hours.

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Specializes in ER, Tele, Cardiac Cath Lab.

:2:

Do not pass go. Do not collect $200.

/QUOTE]

Haha i thought i was the only one that says that!!:lol2:

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

We get a lot of direct admits too. Sometimes it is indeed like putting together pieces of a puzzle.

I love the ones that come in and demand lunch, want all their meds ordered stat, want pain medicine, etc.

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Specializes in ER/EHR Trainer.

If you guys don't like direct admits, you can imagine when the hospital is at full capacity and those "direct admits" with their prescriptions in hand come to the ER and are told to wait-there are no beds. It's funny, lots of ****** off people-95% are usually walking, and don't want to be scheduled as an outpatient. These people do no belong in an ER.

I don't understand:

Why transfusions can't be given in our infusion center?

Why labs should be run today to eval patient? Do it outpatient.

Why MRI, CT or anything else is needed to diagnose a patient in ER for an non-emergent situation?

Doctors have forgotten how to be doctors. They pass the buck to the ER. Sick patients suffer, these patients take beds away from them.

No one leaves the ER unless stabilized. No one coming to the hospital should be going to a floor if in distress or experiencing one of the big 3. SOB, cardiac symptoms, AMS-obviously something is going on and needs to be addressed. The floor is not necessarily critical care.

HOWEVER, anyone walking, talking, or having time to stop for dinner, shopping or anything else is a perfect candidate for direct admit. Honestly I think admitting orders should be faxed and not trusted to their forgetful hands.

JMHO

Maisy

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Specializes in Ante-Intra-Postpartum, Post Gyne.

Sorry this happens to you. In the office I worked at we would fax the info to the ER asap, and if the patient had low b/p or something serious we would take them over in a wheelchair ourselves (our office was behind the hospital) or call the ambulance if it was life threatening.

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Specializes in Cardiology.

I'm sorry to hear this. :( I'm a cardiology office RN and am stunned that so many hospital nurses are having to deal with problems like these. We have a protocol for direct admits in our office -- the patient *has* to have orders, current med list (including allergies) and vitals, EKG done today, NTG and/or ASA on board, O2, last office note, and any other records that may be relevant (recent labs, x-rays, diagnostic procedures, etc.)

It also helps that we have two RNs with years of hospital experience. We know what the hospital nurse is going to need for a direct admit, and we supply as much info as we can. Our docs are good about writing thorough admission orders. And maybe best of all, the practice has a hospital-based NP who is the liaison between the hospital staff and cardiologists. In two years I don't ever remember taking an irate call from a hospital nurse.

I can see, though, where things could get ugly very quickly. It depends on the staff qualifications. If the clinical staff is exclusively MOA's, or even LPN/RN's with no hospital experience, it's pretty clear that they are not going to understand what the bedside nurses need to do their job.

I'm sorry to hear direct admits are such a nightmare for so many. Thanks for raising the issue, though -- I'll keep your post in mind next time we've got one!

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Specializes in Pediatrics.

DIRECT ADMITS WERE THE WORST. well, sometimes they weren't too bad. but, when I would be in charge I would think "if all the traumas need to go to the ED before going to PICU, and a doc wants their patient in the PICU, shouldn't they be triaged in ED as well?" i know that would make for more work for the ED which is not the point, but some of the stuff we got was BOGUS. We got a PICU admission from Radiology b/c the girl swallowed a piece of plastic spoon.....A WEEK AGO. Now, if this girl needed AN ICU BED, don't you think someone PALS certified should transport the girl? No, she was brought up by an x-ray tech and was skipping down the halls of the PICU. NICE.

Other direct admits can be downright scary. A teenager was in the beginning stages of Diabetic Ketoacidosis. The doctors office CALLED HER A CAB and sent her to the PICU. Um HELLO? Ever head of an ambulance? They can start lines, start fluids, maybe try to control the sugar a bit until she gets to the PICU? Um, maybe have the means to establish an airway should she become more acidotic and unresponsive? No no, we will just call her a cab. YIKES!!!

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Specializes in PCU, Home Health.

This all makes me think of when the doc told me (about 9 years ago) to go to the hospital for preeclampsia. I stopped and had my hair cut first. I was just stupid. I didn't mean any harm by it. But as you can imagine, several years later when I was learning about what could have happened to me and my dd, my jaw dropped. DUH!

But today I particularly enjoy the direct admits that we expected about 2 pm and they come rolling in at about 6:30, they take "a little white pill at breakfast and a green pill at bedtime." Their pharmacy is closed and their doctor is not on call. The consult doc is ticked because he was already home eating and the next shift doesn't know why the admit stuff is not done. Ugh.:smokin:

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Specializes in Utilization Management.

Docs (and some ER folks) do not seem to understand that we do not have the resources to cope with a direct admit experiencing chest pain. Even if he does come with orders.

True story: I have 5 or 6 other patients, then a CP r/o MI patient comes in. I have to assess, get vs, height, weight, allergies, drop a line, draw labs, give an ASA, and do an EKG, not to mention that the patient is having CP the entire time, and needs NTG and monitoring while it's given.

The patient waited 4 hours before actually coming to the hospital (everyone knows that packing a bag and having lunch is so much more important than heart tissue :rolleyes:), and then came to the room and failed to let anyone know he was there. Refused the O2. Laughed when I explained how an ambulance crew could've started all these things.

I did almost all of the admission paperwork and was just about through with it--thank the Lord my other patients didn't need anything--when the trop came back incredibly high, the patient was still c/o 8/10 CP, his BP was through the roof, and I couldn't pull the BP med because we cannot override anything but ASA and NTG on my floor.

I put a stat call out to the cardiologist and before he called back, a colleague showed up to transfer the patient to ICU. I gave the patient morphine, started the NTG gtt, and by then my charge nurse had gotten me some reinforcements to get him transferred with the monitor and O2 (which I'm sure he pulled off as soon as no one was looking).

Everything was done in the legal time frame, but I still have nightmares about what might've happened if a non-tele nurse had taken this patient. What if one of my other patients had a significant medical need during this little fiasco?

I documented my butt off too, just in case the blase attitude of the patient later twisted around 180 degrees into concern for the gravity of the situation and his survivors went for a lawsuit.

Anyhow, I haven't had any CP r/o MI direct admits since that one and I haven't heard of any to our unit, either :D

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Specializes in ER/EHR Trainer.

Angie,

That's terrible-I wonder if that patient's PMD really explained what was going on or if figured the hospital would. Happens all the time, we are the bearers of bad news.

Thank God, he had you! He may have sat if he didn't, it's crazy!

Maisy

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Angie,

That's terrible-I wonder if that patient's PMD really explained what was going on or if figured the hospital would. Happens all the time, we are the bearers of bad news.

Thank God, he had you! He may have sat if he didn't, it's crazy!

Maisy

Ya with docs explaining, luckily all my specialists do. I have had a bunch of MRI's recently and they are always like "your doc scheduled you for an mri" i say that i know that and they are so happy because not all of the docs do, the leave radiology to do it. That is hard on the desk workers in radiology who do the calling.

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Specializes in Utilization Management.
Angie,

That's terrible-I wonder if that patient's PMD really explained what was going on or if figured the hospital would. Happens all the time, we are the bearers of bad news.

Thank God, he had you! He may have sat if he didn't, it's crazy!

Maisy

Can you believe that the patient said that the high BP was my fault because I refused to give him a sandwich?

hahahahhahahahhhaaa!!!

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