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.
- AOD will confirm patient is appropriate for this pathway
- 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
- 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)
- Maximum of one patient per day (if a second arrives, they will be managed by the ED until 1pm the following day)
- 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.