Harbor:Placement patients

• Placement Pathway March 2025
  • Effective 3/6/2023, revised 3/26/2025 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)
  • Help set patient and family expectations
  • Consult PT/OT ("Physical/Occupational Therapy Consult and Evaluation Inpatient" - no not use outpatient)
  • Consult SW
  • Place InterQual request
  • Notify DEM AOD of "placement pending" patient as soon as identified
    • Provide the following information via TEAMS chat to the AOD;
      • If during placement hours (7a-4p) and no response from AOD within 1 hour, please text or call (do not call overnight just to notify of the placement patient, just send the info via Teams):
        • Patient name, MRN#, ED Room #, Team (purple/green)
        • Brief clinical info (age, comorbidities, how the patient arrived to ED [family, EMS, as a trauma], where pt came from [home, SNF, HL])
        • 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 any status updates from these services)
        • Insurance information (from demographics tab: DHS empaneled vs OOP, specific type of primary insurance and secondary insurance)
  • Ensure home meds are initiated if the patient will be in the ED for an extended time

• Once reviewed by the ED AOD for pathway appropriateness:
  • From 7am - 4pm, 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 (Lomita or Wilmington Clinics) will go to the FM service
    • The ED should use the "Place in Observation" order, NOT Request for Admit

Remind the admitting team to NOT complete the "ADMIT to INPATIENT" order on the multiple "admit" templates (this order creates the hospital admission icon which should not happen with these patients!)

• Additional Notes:
  • PT/OT/SW/UR must be consulted at the time of placement pathway, but they will likely be in various stages of completion
  • ED AOD will notify the UR/SW/Inpatient Directors via Teams chat
  • ED assigned SW and UM support are responsible for post-discharge placement
    • After 24 hours in ED bed on Placement Pending status, the patient will be admitted as Inpatient. UM staff will track duration of Placement Pending status and communicate with the care team.
  • If the Medicine/Family Medicine service identifies acute illness for which they desire inpatient admission, service should communicate with UM.
  • 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

• Other Placement Patient Considerations:
  • [Home Health] – takes 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.
  • 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.
  • 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