Template:Harbor Admission Guidelines

Admission Guidelines

The following guidelines for specific medical disorders are intended to expedite care of ED patients. They have been reviewed and agreed upon by all Departments and Divisions that provide consultation to the Adult ED.

• Aortic Aneurysms
  • Traumatic thoracic aortic injury: Admit to Trauma Surgery
  • Non-traumatic thoracic aortic dissections:
    • Type A, or with complication (hypotension, aortic insufficiency, vascular occlusion, tamponade): Cardiothoracc Surgery
    • Type B: Medicine, with CT Surgery consultation
  • Abdominal aortic aneurysm: Trauma surgery, or vascular surgery if immediately available
• Brain Death
  • Admit to the service who would have cared for the primary illness or injury
  • Admitting service should notify organ donation agency
• Burns
  • Transfer to a hospital with a burn unit, if admission is required
  • Trauma surgery to provide consultation and admission if burn unit bed unavailable
• Cellulitis(Non-maxillofacial)
  • Admit to medicine with the following exceptions
    • Upper extremity (hand to the antecubital fossa): Hand call (plastic surgery or ortho)
    • Necrotizing fasciitis or requiring surgery in 24 hours: Trauma Surgery
• Clotted dialysis graft: Admit medicine, with inpatient vascular surgery consultation
• Decubitus Ulcers
  • Wound care primary indication for admission: Plastic Surgery
  • Placement, management of medical problems: Medicine
• Deep venous thrombosis
  • Women, suspected DVT < 6wk postpartum: OB
  • Women, followed by gyn-onc, < 6wk post-op by gyn-onc: Gynecology
  • Post-operative DVT, < 6wk post-op: Surgical service who performed operation
  • All other DVTs: Medicine
• Delirium/Dementia
  • Acute delirium: Medicine
  • Established dementia: Medicine
  • New onset or previously undiagnosed dementia: Neurology
• GI Bleeding:
  • Upper gastrointestinal bleeding: Medicine, with trauma consultation if patient is unstable
  • Lower gastrointestinal bleeding: Trauma Surgery, with appropriate consultation as needed for unstable medical conditions
• Hand Injuries:
  • Open and closed fractures of the forearm and hand: Orthopedics
  • Soft tissue injuries of hand up to AC fossa: Hand call (ortho or plastics)
• Intracranial mass lesions:
  • Solitary lesion with no other significant medical problem: Neurology (note, HIV positive or suspected HIV infection does not constitute significant medical problem)
  • Non-hemorrhagic intracranial mass lesion with urgent or emergent medical problem: Medicine
  • Solitary intracranial lesion at risk of herniation: Neurosurgery
• Lower back pain:
  • With neurologic deficit (motor, sensory or reflex): Neurosurgery
  • Without neurologic deficit: Orthopedics
• Maxillofacial trauma:
  • Soft tissue and bony injury: Face call
  • Orbital floor fx with ocular injury: Ophthalmology
• Maxillofacial injections
  • Infections involving orbit: Ophthalmology
  • Dental infection or odontogenic abscess: OMFS
  • Infection of sinuses, complicated dental infection with facial and/or neck extension: Head and Neck Surgery
  • Other maxillofacial infections: Face Call
• Meningitis
  • Even MRN: Medicine
  • Odd MRN: Neurology
  • Significant medical problem not including positive HIV: Medicine
• Osteomyelitis requiring admission:
  • Even MRN or with urgent/emergent medical problems: Medicine
  • Odd MRN or requiring surgical management: Orthopedics
• Painless Jaundice:
  • Medicine
• Pancreatitis:
  • First episode, or patient who may require surgery: Trauma Surgery
  • Recurrent: Medicine