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Care of Emergency Department Patients Admitted to Hospital Services (2.1.1)

Care of Emergency Department Patients Admitted to Hospital Services (2.1.1) - Policies, Clinical, UW Health Clinical, General Care and Procedures, Admission, Discharge, Transfer

2.1.1


UW HEALTH CLINICAL POLICY 1
Policy Title: Care of Emergency Department Patients Admitted to Hospital Services
Policy Number: 2.1.1
Category: UW Health
Type: Inpatient
Effective Date: December 28, 2017

I. PURPOSE

To facilitate care of patients remaining in the Emergency Department (ED) after admission to an inpatient
service and to ensure practice is consistent with The Joint Commission Leadership Standard, which states
“the hospital plans for the care of admitted patients who are in temporary bed locations, such as the post
anesthesia care unit or emergency department.”

II. DEFINITIONS
Admitted patient: A patient who has a decision to admit order placed in Health Link (HL)
III. POLICY ELEMENTS

A. Patients in the Emergency Department (ED), who have had an inpatient-bed requested in Health Link will
have their inpatient orders initiated by the ED nursing staff four (4) hours after the bed request was placed.
These inpatient orders will be entered in Health Link by the admitting service per UW Health Clinical Policy
#3.4.2, Patient Care Orders.
i. Inpatient medication orders will be reviewed and verified by a pharmacist.
a. No medications from the inpatient orders should be given if they have not been verified by
a pharmacist.
ii. Additional inpatient orders will be prioritized and activated by the ED nursing staff and will focus on
the following:
a. High priority laboratory studies
b. High priority diagnostic studies (e.g. CT, MRI, EEG)
c. Frequency of vital signs and focused system assessments
d. Diet orders
iii. Exclusion: If the patient will be going to the OR, the ED staff will not release the orders as they are
typically post-operative orders. In this situation, the ED RN will call the admitting team to clarify
what orders should be released and performed.
iv. Note: Inpatient Care Team Leader or unit RN of appropriate admitting service can be used as a
resource for ED RN questions about implementation and execution of orders. The ED RN will call
above resource on unit with questions.

IV. PROCEDURE

A. The admitting resident or attending physician will add his/her name to the treatment team in Health Link.
B. The admitting resident manually adds the patient’s name to his/her patient list.
C. The admitting team will work with the ED nurse to conduct and coordinate ongoing medical care.
D. The ED nurse caring for the patient can be reached by calling the ED and asking to speak to the patient’s
nurse.
i. University Hospital (UH): 608-262-2398
ii. The American Center (TAC): 608-440-6252
E. The admitting attending physician will assume responsibility for the medical care of the patient after the
patient has been in the ED for greater than four hours waiting for inpatient bed. The ED nurse will contact the
admitting team for questions, concerns or patient status changes while the patient is in the ED.
F. An ED Coordinator will monitor the length of time admitted patients remain in the ED and notify the
admitting team and ED RN at four (4) hours from the decision to admit. Notifications w ill continue at eight (8)
hour intervals until the patient is moved to an inpatient bed or the patient is discharged.


UW HEALTH CLINICAL POLICY 2
Policy Title: Care of Emergency Department Patients Admitted to Hospital Services
Policy Number: 2.1.1


G. At hour four (4) the RN will release all signed and held medication orders while prioritizing additional
inpatient orders for release as described in the aforementioned policy elements section.
H. Any changes in the patient’s condition requiring emergency intervention will immediately be reported to the
ED attending physician, who will be responsible for re-evaluation of the patient and initiation of emergent
therapies and diagnostics as indicated.
i. The ED attending physician will communicate this change in status to the admitting team.
ii. Changes not requiring emergency interventions will be reported to the admitting team by the ED
nurse.
iii. If the level of care has changed, a new bed request will be submitted.
I. If the patient is ready for discharge prior to transferring to an inpatient bed, the admitting team and the ED
attending physician w ill collaborate to discharge the patient from the ED.
i. Utilize the ED After Visit Summary (AVS) to enter discharge instructions.
ii. Follow-up appointments
iii. Discharge prescriptions
iv. Cancel the bed request order
v. Enter a discharge note in the patient’s record
IV. COORDINATION

Author(s): Vice Chair of Quality and Operation, Emergency Medicine
Senior Management Sponsor: SVP/Chief Nurse Executive; SVP/Associate Chief Med Officer
Reviewers: Director, Emergency Services; Clinical Associate Professor – Medicine - Hospitalists; Chief
Medical Informatics Officer
Approval committees: Emergency Department Quality and Clinical Operations Committee; UW Health
Clinical Policy Committee; Medical Board
UW Health Clinical Policy Committee Approval: November 20, 2017

UW Health is a cohesive, united and integrated academic medical enterprise comprised of several entities.
This policy applies to facilities and programs operated by the University of Wisconsin Hospital and Clinics
and the University of Wisconsin Medical Foundation, Inc., and to clinical facilities and programs administered
by the University of Wisconsin School of Medicine and Public Health. Each entity is responsible for
enforcement of this policy in relation to the facilities and programs that it operates.
V. APPROVAL

Peter Newcomer, MD
Chief Clinical Officer

J. Scott McMurray, MD
Chair, UW Health Clinical Policy Committee

VI. REFERENCES

UW Health Clinical Policy #3.4.2, Patient Care Orders

VII. REVIEW DETAILS

Version: Revision
Last Full Review: December 28, 2017
Next Revision Due: December 2020
Formerly known as: N/A