Harbor:Placement patients

For any potential placement needs, contact social work and UR ASAP

• Consider if there are any acute medical needs:
  • Abnormal labs? AKI? Dehydration?
  • delirium?
  • UTI?
  • needing IV pain control? especially if pain is reason for declining PT/OT evals
  • wound care needs?
• Set expectations with patient and family that there are other options
• SNFs are typically able to take patient’s back and can arrange higher level of care, they must hold bed for 24 hours by law. Could try to address patient/family’s concern with current SNF.
• [Home Health] – take a few business days to arrange, options for wound care, PT or OT evals, home hospice, home safety, home infusions, home health nurse eval, etc.
• DHS or MHLA patients may be admitted if unable to find timely placement from the ED.
• Non-DHS or OOP placement patients CANNOT be admitted to Harbor, if there is no acute medical need.
  • No longer have ‘obs status’ anymore so these patients can NOT be admitted to ED hospitalist on short stay unless the insurance plan gives authorization.
  • Some general tips to help get these patients placed from the ED.
    • Escalate DEM AOD (Check ByteBloc, posted in doc boxes)
      • Once it is determined there is not an acute medical need (Abnl labs like AKI? Dehydration? UTI? Delirium?) then, the 1st attending that makes this decision should contact AOD to inform them of the situation.
      • AOD will help escalate to the UR/SW/Inpatient Directors. Info that we need from you:
        • Patient MR#, ED Room #, Team (purple/green)
        • Brief clinical info (age, comborbidities), how the patient arrived to ED (family, EMS, as a trauma)
        • Reason for need for placement (e.g. can’t do ADLs, dementia, abuse, etc.)
        • Skilled nursing needs? Wound care issues?
        • PT/OT/SW/IQ all requested and what stages we are in.
        • DHS eligible, empaneled, type of primary insurance and secondary insurance.
    • Ensure home meds are initiated. It’s possible that the patient may need to stay in the ED overnight or longer. Don’t want anyone going into DKA or HTN crises.
      • SW options: Housing for health, recup care, board and care, etc.
        • Physician may need to fill out some paperwork to initiate process, please do so.
        • Upon discharge, will need prescriptions in hand of all home medications.
      • UR/Insurance options: SNF, acute rehab, etc. will need PT/OT evals before placement.
        • Clarify if both are needed or just PT eval.
        • If in doubt, just place the order for PT eval and another order for OT eval, and then call Rehab Services x67395.
          • If any issues, can call Leslie Porter, Director of Rehab Services, 3xx-880-3247
          • ED PT/OT evals for placement are given priority given the urgent nature.
        • Do not need prescriptions at discharge.
      • Patient's that need outpatient HD chair, coordinate with the HD social worker as well (through SW consult)
      • GeriPsych: If patient is on a 5150 (or vol w/ psych hx) and age =/>65yo with medical issues that need hospitalization, then could consider College Hospital's GeriPsych unit.

See Also

• Harbor:Main