Over the past several weeks, there have been a lot of policy/procedure changes when it comes to what to do when we get a call from the ED for patient admission, but there is no inpatient bed availability per the NOD.
As of now, when there is no inpatient bed availability (confirmed with the NOD), and you receive a call from the ED with a consult for admission, we are REQUIRED to evaluate the patient and complete a consult note with care recommendations. It is okay to ask the consulting ED physician if they have a specific clinical question they would like addressed, and by all means, you should address that clinical question. However, even if there is not a specific clinical question and they are contacting IM with a “consult for admission”, you MUST go and evaluate the patient and provide recommendations via an IM Consult Note. The patient is still under the care of the ED team, the ED team is primary, and we as IM are consultants in this scenario.
To be explicitly clear: IM will NOT continue to follow the patient while they remain in the ED; the patient will not be placed on an IM Team while they remain in the ED; DO NOT place admission orders; IM will NOT place orders for the patient while they remain in the ED. Please inform the ED of your recommendations and politely remind them that IM will sign-off after submitting the consult note. Also, politely remind them that if/when an inpatient bed becomes available, then THEY must contact IM again with a new consult for admission.
Below I have provided a standard example/template of what you should include in your IM Consult Note during this situation. Please copy this and save it as a dot phrase to use moving forward:
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Internal Medicine Service will sign-off at this time.
If the NOD communicates that a hospital bed becomes available for this patient, you must re-consult for admission and call Internal Medicine via regular admission procedures to alert our service that there is now a bed available.
If you have a new clinical question that you would like addressed prior to an inpatient bed becoming available, please call IM for an additional consult.
IM Duty Resident (0600 – 1600 & 1830 – 0600): 619-218-0614
IM Blue Resident (1600 – 1830): 619-643-8939
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The WHY behind this procedure change:
Since there are no beds available, there is the potential for the patient to remain in the ED for many hours awaiting bed availability or until transferred to an outside hospital. During this time, the ED team has already very likely completed their stabilization of the patient and initial work-up to the extent that they are trained and expected to do. When they are calling for admission, but no bed is available, they are simply asking for our assistance/recommendations for next steps in care (work-up, management, etc) for what would take place if/when the patient is admitted. The goal of this is to help avoid significant delays in care for the patient, and to begin the management that would have started to take place had an inpatient bed been available at that time.
If/when in doubt on what to do, just ask your Attending, reach out to myself or Frances, or contact our new inpatient DIVO Dr. Davis.
I appreciate your continued flexibility and great efforts to adjust to these ever changing policies, all while providing top notch care to our patients! Your work does not go unnoticed!
V/R
Peyton
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