Harbor:Placement patients

Effective 3/6/2023 per Dr. Goolsby (EM) and Dr. Thomas (IM) Chairs

• EM physician responsibilities:
  • Evaluate for any medically necessary admission needs (lab abnormalities, AKI, dehydration, UTI, delirium, pain mgt, wound care)
  • Consult SW
  • Consult PT/OT
  • Place Interqual request and call UM
  • Set patient and family expectations
  • SNFs must hold the bed for 24 hours and can take the patient back to arrange for transfer to a higher level of care for longer-term needs as long as the current situation is safe for the patient
  • Notify DEM AOD of "placement pending" patient as soon as identified
    • AOD will confirm patient is appropriate for this pathway
      • AOD will notify the UR/SW/Inpatient Directors
      • Please include:
        • Patient name, MRN#, 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.
  • At 1–2pm, care of the patient should be transferred to an inpatient team:
    • Sunday, Monday, Wednesday, Saturday - call next admitting team on the template
    • Tuesday, Thursday, Friday - call the hospitalist
    • DHS patients empaneled to Family Medicine will go to the FM service
  • Remind the admitting team to NOT PLACE REQUEST FOR ADMIT order

• Fine Print
  • Maximum of one patient per day (if a second arrives, they will be managed by the ED until 1pm the following day)
    • Ensure home meds are initiated if the patient will be in the ED for an extended time
  • Use the "Place in Observation" order, NOT Request for Admit
  • After 48 hours in ED bed on Placement Pending status, patient will be admitted as an inpatient. UM staff will track duration of Placement Pending status.
  • DEM AOD will track placement pending patients (MRN, arrival date, discharge date, insurance, conversion to inpatient)

• Other Placement Patient Considerations:
  • [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.
    • 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.
      • If UR is suggesting a transfer to Rancho Los Amigos (RLA), then place the ‘consult to Transfer Center’ order. The Transfer Center is a county entity that helps transfer patients between county facilities.
    • Clarify if both are needed or just PT eval.
      • ED PT/OT evals for placement are given priority given the urgent nature.
      • 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
      • 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