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American Family Children’s Hospital (AFCH) Admissions (2.1.29)

American Family Children’s Hospital (AFCH) Admissions (2.1.29) - Policies, Clinical, UW Health Clinical, General Care and Procedures, Admission, Discharge, Transfer

2.1.29


UW HEALTH CLINICAL POLICY 1
Policy Title: American Family Children’s Hospital (AFCH) Admissions
Policy Number: 2.1.29
Category: UW Health
Type: Inpatient
Effective Date: August 28, 2017

I. PURPOSE

To ensure that inpatients 18 years 11 months of age of age and younger being cared for by a pediatric
provider are placed in American Family Children’s Hospital where they will receive optimal medical, nursing,
and ancillary services and where the psychosocial needs of the patient and family can best be met. This
policy has been developed to serve the best interests of infants, children, and adolescents within the current
hospital environment. This pertains to patients at The American Center, University Hospital and American
Family Children’s Hospital.

II. POLICY ELEMENTS

Goals of the Children’s Hospital:
A. To provide patient and family centered care which encourages and supports parents and/or guardians and
other persons most significant to the hospitalized child to be active members of the healthcare team.
B. To provide the highest quality and safest care for children and families by clinicians expert in their discipline
as well as expert in the care of infants, children and adolescents.
C. To provide an opportunity for children with similar developmental and psychosocial needs to be cared for in
an optimal healing environment.
D. To provide services which assist the child and family in their psychosocial adjustment to hospitalization and
illness.
E. To provide opportunities for recreation and education suited to the hospitalized child's age and condition.
F. To facilitate the continued development of pediatric health care professionals who are able to respond
effectively to the unique physical, emotional, and developmental needs of children.

III. PROCEDURE

The guiding principle for admission to the American Family Children's Hospital (AFCH) is that no child who
has been determined to be clinically appropriate for admission will be refused admission without the joint
approval of the Medical Director or designee and the Director of Pediatric Nursing.

A. Criteria for admission to the AFCH:
i. All pediatric trauma and pediatric patients requiring critical care services will be admitted to the
PICU.
ii. Pediatric Hematology/Oncology and bone marrow transplant patients will be admitted to P4.
iii. Neuroscience, Otolaryngology, and Plastic/Reconstructive patients will be admitted to P4 unless
their admission would cause displacement of a hematology/oncology patient. In that situation,
these patients would be admitted to P5.
iv. If P4 is at bed capacity the pediatric hematology/oncology patient will be admitted to the PICU but
remain on the Hem/Onc Medical Service.
v. Pediatric patients requiring mechanical ventilation, who do not require critical care, and who have
a stable, artificial airway that is not an endotracheal tube will be admitted to the Universal Care
Unit. .
vi. Pediatric patients admitted for diabetes not requiring critical care will be admitted to the Universal
Care Unit. .
vii. Post-operative pediatric spinal fusion patients not requiring critical care will be admitted to the
Universal Care Unit. .
viii. Video EEG and sleep study patients will be admitted to the Universal Care Unit.
ix. P5 is the designated admitting floor for all pediatric patients not assigned to P4, The Universal Care
Unit, or Critical Care.
x. If P4, P5, and the Universal Care Unit are at capacity, PICU will be designated as the pediatric
overflow unit as beds are available. Under these circumstances PICU should maintain the ability to
admit a critical care patient. If this is not possible, the PICU attending, AFCH Medical and Nursing
Directors, and AFCH administrator or designees should develop the plan for a critical care
admission and/or placement of other pediatric patients.



UW HEALTH CLINICAL POLICY 2
Policy Title: American Family Children’s Hospital (AFCH) Admissions
Policy Number: 2.1.29

xi. For pediatric patients requiring placement when AFCH is at bed capacity, admissions will be
triaged according to the acuity of the clinical needs of the child. Patients will not be refused
admission without joint permission of AFCH Medical and Nursing Directors or their designees.
B. All patients 18 years 11 months of age and younger will be placed on the AFCH inpatient units P4, P5, the
Universal Care Unit, and the PICU, unless one of the following criteria apply:
i. The patient is 16 years or over and admitted for rehabilitation.
ii. A psychiatric patient 18 years or older requiring a bed on a locked unit.
iii. The AFCH Director of Nursing and the Nurse Manager of CTRC will decide the placement of
children who are enrolled in research and who require inpatient admission.
iv. The child is 18 years or older and in the ICU phase of treatment for multisystem trauma.
v. The child is 18 years or older admitted 24 hours or less for orthopedic surgery with no co-morbidity.
vi. Pediatric patients with the diagnosis of burns will be admitted to the Burn Unit and on the Burn
Service.
vii. The critically ill pediatric patient with a diagnosis of burns requiring ventilation will remain on the
Burn Service but co-managed by the Pediatric Intensivists in the PICU.
viii. AFCH Medical and Nursing Directors, University Hospital Nursing Supervisors, and Director of
Security or their designees will work collaboratively to make decisions regarding appropriate
placement for pediatric patients being admitted from a detention facility who have been determined
to be at risk to other pediatric patients, families, or staff.
C. Patients over 18 years, eleven months, and under 22 years of age, may be admitted to AFCH if the needs of
the patient and family would best be met in a pediatric setting and, if there is adequate bed space. Efforts
should be made, however, to prepare adolescents for transition to an adult care unit between the ages of 18
and 21 based on the patient's developmental needs.
D. An attending physician who makes an admitting decision that is not consistent with the above criteria will
consult with the AFCH Medical and Nursing Directors or designees, and/or the appropriate attending
pediatrician to ensure that the patient is placed on the optimal available unit.
i. Before children less than 18 years of age are admitted to adult units, the Director of Pediatric
Nursing or the Nursing Coordinator will be notified by admissions to facilitate nursing consultation
and access to appropriate resources such as Hospital School and Child Life.
ii. When children less than 18 years of age are admitted to adult units and the admission is expected
to extend beyond one week, the patient's attending physician and primary nurse will evaluate the
patient daily for transfer to AFCH.
iii. Patients 22 years of age or older will not be placed on P4, P5, the Universal Care Unit or the PICU
except when adult units are full and there is a need to board an adult in AFCH and only after
discussion with the Director of Pediatric Nursing and the Medical Director of AFCH.
a. Patients 22 years of age or older with single ventricle physiology may be placed in the
PICU, following consultation with pediatric critical care, and/or pediatric cardiology or
pediatric cardiovascular surgery.
E. If all beds in the AFCH (including all PICU beds) are filled:
i. Patients aged 15 years and older will be evaluated for admission to an adult unit by the medical
and nursing staff. Compelling issues to consider in the decision making would be age, severity of
illness, continuity of care, length of stay, and developmental level of the child.
ii. Efforts will be made to accommodate all children requiring emergency admission into the AFCH.
Efforts will be made to maintain an identifiable PICU bed that can be ready within one hour of
notification for emergent situations involving critically ill or injured patients.
iii. Efforts will be made to avoid boarding children under 15 years on adult units.
iv. If all possible beds have been assigned, then elective medical and surgical admissions may be
postponed. This decision will be made collaboratively by medical, surgical, and nursing clinical and
administrative leaders and will be communicated to the admissions department 24 hours in
advance of a scheduled admission.
F. If there are still no beds for emergency admissions after all possible candidates have been boarded on adult
units then transferring stable patients to other hospitals will be considered. This decision would be made
only after careful consideration by the Pediatric attending physician and the Nursing Supervisor, in
consultation with the Director of Pediatric Nursing and the Medical Director of AFCH.
G. Care for patients outside of AFCH:
i. Occasional patients 18 years and under are admitted to adult units.
ii. The following staff are available for consultation on all patients (both inpatient and ambulatory):
a. Pediatric House Staff and Faculty



UW HEALTH CLINICAL POLICY 3
Policy Title: American Family Children’s Hospital (AFCH) Admissions
Policy Number: 2.1.29

b. Pediatric Nurse Practitioners
c. Pediatric Clinical Nurse Specialists and/or expert staff nurse (evening, night, and
weekends contact the Care Team Leader or Senior Team Member on P4, P5, the
Universal Care Unit or PICU)
d. Case Management
e. Child Life Specialist
f. Madison Metropolitan School District Teachers
g. Pediatric Specialists in all other disciplines are also available upon request (e.g.,
Respiratory Therapy, OT, PT, Nutrition, Psychiatry, Health Psychology)

IV. COORDINATION

Author: Director, Pediatric Nursing, American Family Children’s Hospital
Senior Management Sponsor: SVP/Chief Nurse Executive
Reviewers: AFCH inpatient managers
Approval committees: American Family Children’s Hospital Practice Council; UW Health Clinical Policy
Committee
UW Health Clinical Policy Committee Approval: June 19, 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 Hospitals 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. REVIEW DETAILS

Version: Revision
Last Full Review: August 28, 2017
Next Revision Due: August 2020
Formerly Known as: Hospital Administrative policy #7.44