NURSING PATIENT CARE POLICY & PROCEDURE
September 3, 2016
Nursing Manual (Red)
Policy #: 6.34
Title: Guidelines for Placing Patients Off
Service and Returning Adult Patients to
Their Home Unit
To establish a process for alternative,or off-service, placement of adult inpatients and the
coordination of their return to the ‘home unit.’
A. Patients are placed on inpatient units consistent with the treating clinical service.
Circumstances may arise which require alternative placements. In these instances, the
nursing coordinators make placement decisions. Patient placement decisions are the
accountability of the Nursing Coordinator. The Nurse Manager is an available
resource for any clinical discussion. The Nursing Coordinator will collaborate with
the Nurse Manager or designee to determine when and if off-service patients can be
transferred to the ‘home unit’.
B. Policies and procedures exist which guide admissions, transfers and placing off-
service patients in the American Family Children's Hospital (AFCH). Refer to the
1. UWHC Hospital Administrative Policy 7.44, American Family Children’s
Hospital (AFCH) Admissions
2. UWHC Hospital Administrative Policy 7.18, Admission & Discharge Criteria
for Pediatric Intensive Care Unit (PICU)
C. Policies and procedures are to be consulted for the admission and discharge of
patients to the adult ICUsas indicated in the reference section of this document.
D. The guidelines written below do not apply to either the American Family Children's
Hospital or to the ICUs.
A. Off-service placement
1. Alternative nursing units have been identified by nurse managers, nursing
directors and physicians. Off-service units were selected based on patient
acuity, staff knowledge and competencies, availability of telemetry and
IMC and proximity to the home service unit. When circumstances require
alternative placement, decisions are to be consistent with the factors
a. Knowledge and competencies of nursing staff
b. Complexity of care
c. Potential for serious complications
d. Staffing considerations
e. Family issues
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f. Physician opinion
g. Patients well known to a particular unit
2. Transfer of off-service patients back to the home service unit:
The following factors are to be considered when determining whether or
not patients placed off-service should be transferred to the unit of the
treating clinical service ("home" unit). It is recognized that the "home"
unit is likely to be the preferable location for the patient, however, some
factors need to be considered when evaluating a transfer:
a. If a patient is to be discharged within 24-48 hours, consider leaving
the patient on the off-service unit.
b. Specialty care needs of the patient are efficiently met. If not
efficient or effective, transfer the off-service patient to "home"
c. Number of times patient has been transferred during this episode of
illness. If frequent, consider leaving patient on off-service unit.
d. The off-service patient may be transferred to the "home" unit, if
sufficient beds are available for future admits within the next 16
e. Staffing issues on "home" and off-service unit.
f. Physician opinion is taken under advisement.
g. Security patients are evaluated on an individual basis, however, the
security unit is the home unit for all security patients needing
The Nursing Coordinator is accountable for all patient placement
decisions. Decisions are based on bed availability on the treating service
and staffing considerations. The Nursing Coordinator directs Access
Center staff in appropriate unit placement for adult general care patients
based on the aforementioned criteria.
4. Conflict Situations
If conflicts arise regarding a placement decision, the Nursing Coordinator
will confer with the relevant Nurse Manager and the involved
physician(s). If further negotiation is deemed necessary, the appropriate
Nursing Director, the Nurse Administrator on-call and/or the relevant
physician leader will be notified by the Nursing Coordinator.
A. Hospital Administrative Policy 7.18, Admission & Discharge Criteria for
Pediatric Intensive Care Unit (PICU)
B. Hospital Administrative Policy 7.19, Admission & Discharge Criteria for ICU
Status on the Cardiothoracic Surgery and Transplant Unit (Acuity Adaptable
C. UW Health Clinical Policy 2.1.2, Admission/ Discharge of Patients to and from
the Cardiac Intensive Care Unit
D. UW Health Clinical Policy 2.1.18, Admission & Discharge of Patients to & from
the Trauma and Life Support Center (TLC)
E. UW Health Clinical Policy 2.1.16, Admission & Discharge Criteria for Burn Unit
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F. UW Health Clinical Policy 2.1.9, Admission, Care and Discharge of Patients to
and from Inpatient Post-Anesthesia Care Unit (PACU)
G. Hospital Administrative Policy 7.44, American Family Children’s Hospital
H. Hospital Administrative Policy 7.45, Triage of Critically Ill Patients
V. AUTHORED BY
Director, Nursing Operations Support
VI. REVIEWED BY
Director, Nursing Operations Support, September 2016
Nursing Administrative Policy & Procedure Committee, September 2016
Nursing Coordinators, September 2016
Beth Houlahan, DNP, RN, CENP
Senior Vice President Patient Care Services, Chief Nurse Executive