New Admissions
WEEKDAYS
5am-8am: Day Team
8am-11am: Platinum - Meant to protect resident rounds, learning, education
– Attendings may exercise judgment in assigning admits to resident teams
– Depending on Volume/census, good learning cases
11am-5pm: Day Team
5pm-630pm: Housestaff
630pm-5am: Night Team
WEEKENDS
5am-5pm: Day Team (Eyeball/place general orders 5pm-6pm)
5pm-5am: Night Team (Eyeball/place general orders 5am-6am)
5am-8am: Day Team
8am-11am: Platinum - Meant to protect resident rounds, learning, education
– Attendings may exercise judgment in assigning admits to resident teams
– Depending on Volume/census, good learning cases
11am-5pm: Day Team
5pm-630pm: Housestaff
630pm-5am: Night Team
WEEKENDS
5am-5pm: Day Team (Eyeball/place general orders 5pm-6pm)
5pm-5am: Night Team (Eyeball/place general orders 5am-6am)
Direct Admissions
-Start getting admissions direct to the floor (from home and OSH ED)
-Patients will be assigned to teams within timeframe of 15 min prior to arrival-arrival to floor
-Goal: Meet transport at bedside to get in-person signout. (We understand this may not always be possible)
-Evaluate and admit patient as soon as possible upon arrival to floor
-If a patient arrives during Golden Hour, someone from team must eyeball patient and place general orders.
-Patients will be assigned to teams within timeframe of 15 min prior to arrival-arrival to floor
-Goal: Meet transport at bedside to get in-person signout. (We understand this may not always be possible)
-Evaluate and admit patient as soon as possible upon arrival to floor
-If a patient arrives during Golden Hour, someone from team must eyeball patient and place general orders.
PICU and Specialty Primary Admissions
1) Dial x15588 to reach PPC and do 3 way call with PPC for admissions
2) Send photo of White Card back to admitting group text for your attending to review. (Opportunity for attendings to review and check vitals, look for any red flags)
3) Proceed with Admission Process (See next section for details)
2) Send photo of White Card back to admitting group text for your attending to review. (Opportunity for attendings to review and check vitals, look for any red flags)
3) Proceed with Admission Process (See next section for details)
Admission Process
- Place name on ED tracking board under ED All Beds "Covering Physician"
- Place name on Medical Sign Out (Ad Hoc)
- Put your last name AND pager # on the whiteboard
- When interns are sending a consult to specialists, please include/CC your senior. If you are away from the computer, your senior can let you know that the specialist replied, and you can log into a computer to read the recommendations and reply.
- See patient, perform H&P
- Use sensitive notes when appropriate
- Review H&P and plan with senior resident
- Place orders - Use order sets
- IPR vs. OPO
- Med Reconciliation - Patient Safety Issue
- H&P Note
- Discharge Summary
- Ensure diagnoses are updated. Tip Sheet Here
- Huddle with RN at bedside once arrived to floor
- Staff with Attending
Admit Caps
Please click HERE for Resident Admit Times and Caps document. Document reviewed and last updated 10/29/24
Floor Arrival Communication - MD to RN
Acknowledge arrival texts via Voalte
Huddle with RN at bedside to discuss plan of care
Discuss using 5 P's
Checklist (Bottom right hand corner of SummaryM), Click "RN Updated", Change from Red to Green Bear
CLICK HERE FOR FULL DOCUMENT ON INSTRUCTIONS
Huddle with RN at bedside to discuss plan of care
Discuss using 5 P's
Checklist (Bottom right hand corner of SummaryM), Click "RN Updated", Change from Red to Green Bear
CLICK HERE FOR FULL DOCUMENT ON INSTRUCTIONS
Care Guidelines
Utilize care guidelines for majority of diagnoses
–Order Set (Contains)
–Pre-checked nursing/patient care phrases
–Management suggestions: Antibiotics, treatments, consults
–VTM and Ketogenic Readmission Care Guidelines
Can be added on at any time
Can use more than one (ie. febrile neonate, pyelonephritis)
–Order Set (Contains)
–Pre-checked nursing/patient care phrases
–Management suggestions: Antibiotics, treatments, consults
–VTM and Ketogenic Readmission Care Guidelines
Can be added on at any time
Can use more than one (ie. febrile neonate, pyelonephritis)
Trauma Admission Guidelines
-Consult Trauma Team for all traumatic NATs
-Consult SCAN and SW
-If Trauma team would like to be primary, follow up if they also would like Peds Consult
-Consult SCAN and SW
-If Trauma team would like to be primary, follow up if they also would like Peds Consult
PACU Admits
Needs admission order in Cerner prior to being able to move patient out of PACU
-Admit To: Hospitalist order
-Diet
-Pain meds
-Admit To: Hospitalist order
-Diet
-Pain meds
PICU Transfer
Clean up PICU orders
–Change Admit To: Hospitalist
PICU transfers “bounce back” to a team if intern still on service
–Change Admit To: Hospitalist
PICU transfers “bounce back” to a team if intern still on service
Heme/Onc
Hematology
Weekdays:
8a-4p – Hematology division does admission
6p-6a – Night heme/Onc NP does admission
*** if there is no night Heme/ Onc NP – pediatric residents will do admission
*** if a hematology patient arrives during the gaps in NP coverage (ie 6a-8a and 4p-6p), the hematology division or night NP will do the admission when they are able. If the patient is sick and needs someone to “lay eyes” and no one is on campus, pediatric residents can help.
Weekends:
6a-6p – pediatric residents do admission. Staff with hematology fellow/ attending and receive feedback/ education
6p-6a – Night Heme/Onc NP does admissions.
*** if there is no night Heme/onc NP -> pediatric residents will do admission
Oncology:
Weekdays:
8a-4p – Oncology division does admission
6p-6a – Night heme/Onc NP does admissions
*** if there is no night Heme/ Onc NP – pediatric residents will do admission
*** if an oncology patient arrives during the gaps in NP coverage (ie 6a-8a and 4p-6p), the oncology division will do the admission when they are able. If the patient is sick and needs someone to “lay eyes” and no one is on campus, pediatric residents can help.
Weekends:
8a-4p – Oncology division does admission
6p-6a – Night heme/Onc NP does admissions
*** if there is no night Heme/ Onc NP – pediatric residents will do admission
*** if an oncology patient arrives during the gaps in NP coverage (ie 6a-8a and 4p-6p), pediatric residents will do the admission and staff with Oncologist/ fellow to clarify plan and receive teaching.
Weekdays:
8a-4p – Hematology division does admission
6p-6a – Night heme/Onc NP does admission
*** if there is no night Heme/ Onc NP – pediatric residents will do admission
*** if a hematology patient arrives during the gaps in NP coverage (ie 6a-8a and 4p-6p), the hematology division or night NP will do the admission when they are able. If the patient is sick and needs someone to “lay eyes” and no one is on campus, pediatric residents can help.
Weekends:
6a-6p – pediatric residents do admission. Staff with hematology fellow/ attending and receive feedback/ education
6p-6a – Night Heme/Onc NP does admissions.
*** if there is no night Heme/onc NP -> pediatric residents will do admission
Oncology:
Weekdays:
8a-4p – Oncology division does admission
6p-6a – Night heme/Onc NP does admissions
*** if there is no night Heme/ Onc NP – pediatric residents will do admission
*** if an oncology patient arrives during the gaps in NP coverage (ie 6a-8a and 4p-6p), the oncology division will do the admission when they are able. If the patient is sick and needs someone to “lay eyes” and no one is on campus, pediatric residents can help.
Weekends:
8a-4p – Oncology division does admission
6p-6a – Night heme/Onc NP does admissions
*** if there is no night Heme/ Onc NP – pediatric residents will do admission
*** if an oncology patient arrives during the gaps in NP coverage (ie 6a-8a and 4p-6p), pediatric residents will do the admission and staff with Oncologist/ fellow to clarify plan and receive teaching.