Admitting or Transferring a Patient from the FED
Calling for Admission
As soon as the decision is made to admit, place the “Admission/Observation Decision” order in Cerner. (You may decide a patient needs to be admitted 5 minutes after they arrive, so go ahead and enter this order as this ‘stops the clock’ for the ‘Door-to-Decision’ metric with goal of less than 150 minutes.)
Does the patient need a specialist (surgery, trauma, etc)? Call the required specialist first
Sometimes, the specialist will admit, and, other times, the hospitalist will admit while the specialist consults only.
Does the patient require ICU?
YES: call the TTIM ICU Resident
Does the patient have a local PCP?
YES: call the Sound Hospitalist Group at 7400.
My very first statement on the phone is “This is Poage at Town Square (or Georgia) with a patient of Dr. Keister (or whomever their PCP is).
NO: call the TTIM Floor Resident.
My very first statement on the phone is “This is Poage at Town Square (or Georgia). Are y’all capped?”
If the TTIM Resident Service is capped, then call Sound Hospitalist at 7400.
My very first statement on the phone is “This is Poage at Town Square (or Georgia). I’ve already called TT and they are capped.”
Cap does not apply to 30-day bounce-backs nor to their clinic patients
The hospitalist service admits most medicine patients and some surgery and specialist patients.
All Pediatrics: call the pediatric attending – either floor or PICU
Document ALL calls in the “Calls-Consults” section under “Impression and Plan” in your note.
Document ALL calls - even if you just page or leave a message - in the “Calls-Consults” section under the “Impression and Plan” in the note. For more than one call, right-click on ‘(repeat)’ and select ‘repeat’ to document multiple calls/consults.
After you get acceptance from the admitting physician, place the “Admission/Observation/Transfer”.
NOTE: Admission/Observation Decision: you may decide a patient needs to be admitted within 2 minutes of arrival (ex: hypoxic covid pneumonia who comes in with SaO2 81% RA); but may not actually call for admission for another hour because you’re waiting on results, treatment, etc. Please go ahead and enter the “Admission/Observation Decision” order in Cerner as soon as you make that decision. This is how we track that metric, whereas the “Admission/Observation/Transfer” order is the actual order that triggers everything.
What ORDERS do I enter?
What 2 orders do I have to input into the EMR from the FED?
1. Decision for Admission/Observation
2. Admission/Observation Transfer
When placing the AOT order, place the admitting physician name in the ‘Attending Physician’ box.
You also need to ‘right-click’ the order itself, and enter the admitting physician name again and select ‘Phone Order’.
Holding Patients
Do we hold admitted patients in the FED overnight?
The goal is to hold patient no longer than 4 hours. However, longer hold times happen only during times of high hospital census or capacity.
Do we keep observation patients at the FED?
Yes, we do keep observation patients at TSQ. See Observation section
Transfering to NW Main ED
What are the steps for transferring a patient from the FED to the NW MainED?
If a specialist requests to send the patient to the MainED for them to evaluate first, then call the MainED physician to give a verbal check-out.
Check the “ED Call Roster” and make sure you call and speak directly with the MainED physician who has been on-shift the least amount of time, and give a complete verbal check-out.
Document ALL calls in the “Consults” section under “Impression and Plan” in your note.
Document ALL calls - even if you just page or leave a message - in the “Calls-Consults” section under the “Impression and Plan” in the note. For more than one call, right-click on ‘(repeat)’ and select ‘repeat’ to document multiple calls/consults.
Ensure your note is completely done. These are treated as a “Patient Hand-off” - similar to shift-change hand-offs - and the MainED physician will assume care and add an “Addendum” to the chart.
Lastly, ‘Unassign’ yourself from the patient on the Tracking List - this allows the patient to show up on the main ED Tracking List.
Let the charge nurse know that you have acceptance and the patient will be going to the MainED.
What order do I need to enter in Cerner?
If going to NW, enter “Intra Hospital System Transfer to NWT” order
Click HERE to view the NW FED Transfer Policy (updated February 2022)
Transfer to Outside Facility
What are the steps for transferring a patient from the FED to an outside facility? (While keeping to standard regulations, the following are usual transfer patterns for patient safety)
If patient requires specialty-services not available at NW, begin with calling BSA Hospital at 212-7000, then can begin calling out further to UMC in Lubbock at 1 (800)-345-9911, etc
(first dial 9 to get out)
Document ALL calls in the “Consults” section under “Impression and Plan” in your note.
Document ALL calls - even if you just page or leave a message - in the “Calls-Consults” section under the “Impression and Plan” in the note. For more than one call, right-click on ‘(repeat)’ and select ‘repeat’ to document multiple calls/consults.
What order do I need to enter in Cerner?
If going to a different facility (i.e. BSA, UMC, etc), enter “Discharge Request (Transfer Out of Facility Request)” order
Click HERE to view the NW FED Transfer Policy (updated February 2022)
