I hate direct admits

[FireStarterRN]

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.

[MAISY, RN-ER, BSN, RN]

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

hahahahhahahahhhaaa!!!

Of course, it's never them....

Maisy

[pagandeva2000, LPN]

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.

She may have been lying. Most private doctor offices cannot afford to maintain the salary of an LPN, and especially an RN unless it is a large practice.

[FireStarterRN, BSN, RN]

She may have been lying. Most private doctor offices cannot afford to maintain the salary of an LPN, and especially an RN unless it is a large practice.

I told this story to a friend of mine and she knows the woman and said that she is an RN

[pagandeva2000, LPN]

I told this story to a friend of mine and she know the woman and said that she is an RN

Thanks for the clarification-now, it makes me wonder more why the proper things were not done.

[FireStarterRN, BSN, RN]

I wonder that myself, Pagan, but it seems to happen a lot with direct admits. There is often an information gap.

[pagandeva2000, LPN]

My hospital claims that we are supposed to communicate using SBAR, but, I have yet to be able to utilize my new skill because when I call med surg (I am an LPN in the clinic) with a direct admit, they usually collect the name and then hang up. I'd love to be able to communicate that way, but, have not had a chance to practice SBAR.

I also hate direct admits, from being on my side of the fence. Maybe we should partner up...they'd get better care.

[Dolce, RN]

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

hahahahhahahahhhaaa!!!

He probably had severe sandwichemia. That has been known to cause many deadly MIs.

[nuangel1, BSN, RN]

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 ), 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

i most certainly appreciate your situation but at the same time that particular pt should not have been a direct admit .that pt should have been sent to ed first anyone who has cp sob arrthymia thats unstable ,unstable vs should not qualify as a direct admit .that is the pcp 's fault .but we routinely get pts in the ed who wait hrs or days for admit in ed because we don't have beds.for ex a pt with stable afib that need labs and w/u for say a cardioversion or cardiac meds changed. there is no reason that pt can't have labs and w/u outpt and then be a direct admit .another ex.the pts with hx of anemia that the dr see's hct is doing slow decline ,vital signsstable pt asx and send the pt to ed at 4pm on friday for transfusions .all this pt needs is transfusion it could be setup in say day surg dept (would require the pcp to set it up) and the type and cross done outpt then send as direct admit with orders for transfusions.when the pt is sent to ed for this it ties up ed bed .

the pts get upset when we tell them we won't do transfusions in ed because they are stable and each transfusion takes hours so they will be admitted over noc for the blood.its so easy these days for the pcps and other drs who don't want to do an evaluation. all they say to the pt is go to the er .then they wonder why we don't have beds and the pts sit in the waiting room or halllway .we do all the workup and then that dr admits the pt based on our work.its ridiculous and is one reason the eds are over flowing with non critical pts .we hold 5-16 admited pts in our ed everyday .we are only 18 beds with 8 bed fast track.then the pcp or other dr call and wonders why we won't seee their pt immediatley .if pt is not critical the pt goes thru triage like every one else.i love it when the pt says i was sent in by my dr when asked why they have no idea .then we have to figure it out.

[CHATSDALE]

if a md decides that a presenting patient needs to go to hospital they need to call an ambulance because the patient will invaribly go into denial and think about everything they are going to need in hospital

personal items, pjs, reading material

i think everyone should carry on their person a list of prescribed meds, someone to contact in emergency and the name of their doctor

just in case when you get to er subconsious they know if you happen to be on coumadin - etc

look out for yourself

[lpnstudentin2010, LPN]

....i think everyone should carry on their person a list of prescribed meds, someone to contact in emergency and the name of their doctor

just in case when you get to er subconsious they know if you happen to be on coumadin - etc

look out for yourself

I recently started doing just this. I made one of those printable cards with medical info on them. it has my name, medications, allergies, medical conditions, and a docs info (I chose the doc who knows me the best not my primary care but she knows every inch of me, my extensive history, and is the doc I have been with the longest. But she is not my primary, she is my geneticist though a lot of her exam is the same as a primary)

[KaroSnowQueen, RN]

I hated direct admits when I worked the floor. As you all have said, they would often go home, bathe, eat, pack a bag, then come dragging in three or four or more hours later. Then the MD office did NOT send any orders, the patients were p.o.'d because I couldn't so much as give them a glass of water as I had no orders. Call the doc, get the on call who has no idea who the patient is or why they're there. Often would take over an hour to get the original doc on the horn, he doesn't have the pt's med list memorized (altho the pt is SURE he does), all the pt knows is 'I take a pink pill and a green one and maybe one for blood pressure, don't you have my records here somewhere???'. Then you have to try to start a line on someone who is sick, dehydrated, whatever and draw blood and explain what you're doing and why you're doing it, and they say 'Dr Soandso just said you'd give me some (whatever medication the pt thinks the doc said), and I'd be ok and could go home in the morning.' Yeah, right. Not to mention the online charting and admisssion forms and assessments, etc, etc, etc.

I wish to heaven if a doc is sending a direct admit he would send copies of current med list, his current notes so we know WHY this pt is REALLY coming - nine times out of ten what we get via phone from the admitting office is NOT what they're really here for. Direct admits are one reason I am glad to be off the floor, we ALL hated them with a passion.