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Admission and Discharge of Patients to and from the Medical Cardiology Intermediate Care Unit (IMC) (2.1.3)

Admission and Discharge of Patients to and from the Medical Cardiology Intermediate Care Unit (IMC) (2.1.3) - Policies, Clinical, UW Health Clinical, General Care and Procedures, Admission, Discharge, Transfer

2.1.3


UW HEALTH CLINICAL POLICY 1
Policy Title: Admission and Discharge of Patients to and from the Medical Cardiology
Intermediate Care Unit (IMC)
Policy Number: 2.1.3
Category: UW Health
Type: Inpatient
Effective Date: May 7, 2015

I. PURPOSE

To ensure appropriate use of the Medical Cardiology Intermediate Care Unit and to outline guidelines for the
admission and discharge from the Medical Cardiology Intermediate Care Unit (IMC).

II. POLICY ELEMENTS

A. Scope of Service
i. The Medical Cardiology IMC has been designed to care for the adult patient w hose care
requirements are betw een that of an intensive care unit and the general care f loor. Their
specialized cardiac-related primary disease processes make transfer to other IMC units less
desirable. These patients may require frequent cardiovascular assessments along w ith
technological monitoring to quantify parameters for early recognition and treatment of potentially life
threatening events.
ii. Examples of patients best admitted to IMC status on the Medical Cardiology Intermediate Care Unit
are:
a. Patients in need of frequent, detailed cardiovascular assessments (monitoring of cardiac
rhythm, vital signs, and other systems) minimally every 4 hours for a prolonged duration.
b. Patients w ho are stable and aw aiting placement of permanent pacemakers.
c. Patients w ho require loading doses and continuous infusions to maintain hemodynamic
stability or maximize cardiovascular function that are consistent w ith UW Health
Intravenous Administration of Formulary Medications – Adult – Inpatient/Ambulatory
Clinical Practice Guideline. Refer to UWHC policy #8.31, Guidelines for Hospital Location
Specif ic Administration of IV Medications.
d. Oral loading of anti-arrhythmic agents such as dofetilide and sotalol.
e. Patients w ho are stable, but need closer monitoring due to the discontinuation of multiple
sheaths post cardiac procedure.
f. Patients w ho are stable, but need close monitoring due to the administration of vasoactive
medications that are consistent w ith UW Health Intravenous Administration of Formulary
Medications – Adult – Inpatient/Ambulatory Clinical Practice Guideline.
g. Patients w ho are hemodynamically stable but are experiencing rhythm disturbances that
may lead to hemodynamic instability (such as runs of Ventricular Tachycardia,
Supraventricular Tachycardia, or pacemaker failures).
h. Cardiology patients w ho need Intermittent Positive Airw ay Pressure/Bi-Positive Airw ay
Pressure (BiPAP) to prevent acute hypoxemia or hypercapnia or use of continuous CPAP
or BiPAP at night for chronic conditions.
i. Post cardiac procedure patients w ho experience unstable hematomas.

III. PROCEDURE
A. Admissions Process.
i. Patients w ho meet the admission criteria w ill be admitted to the Medical Cardiology IMC by the
CVM inpatient or Procedure Services through arrangements w ith the Patient Placement
Coordinator and the Care Team Leader or Charge Nurse.
ii. It w ill be considered highly unlikely for patients on other services to be admitted to the Medical
Cardiology IMC w ithout consideration for transfer to the CVM inpatient service or obtaining a
cardiology consult. In the event that patients from other services are considered for admission
Patient Placement Coordinator, and/or medical director w ill consult w ith the Nurse Manager (NM)
or designee as to the patients most suited to the unit.
iii. In the event that patient volume exceeds the bed capacity, the Patient Placement Coordinator w ill
w ork w ith the NM or his/her designee and appropriate medical service to assist in placement of
patients in the unit best suited to the situation.
B. Transfer Criteria.



UW HEALTH CLINICAL POLICY 2
Policy Title: Admission and Discharge of Patients to and from the Medical Cardiology Intermediate Care Unit (IMC)
Policy Number: 2.1.3

i. Patients considered medically stable and w ho no longer meet IMC criteria.
C. Transfer Process.
i. The nursing and medical staff w ill review the patient condition and readiness for transfer daily.
ii. A transfer order must be submitted to transfer the patient from the IMC indicating the service, level
of care and attending physician responsible for care during the patient’s stay.
iii. Order reconciliation must be completed by the primary service at the time the patient is transferred
from IMC.
iv. In the event that the patient is discharged from the IMC to another facility, guidelines identif ied by
the coordinated care off ice w ill be follow ed.
IV. DISCHARGE

Patients may be discharged form the IMC w hen a discharge from the hospital is appropriate, it w ill be
completed according to UWHC policy #7.15, Discharge Planning Process.

V. CONFLICT RESOLUTION

Conflicts w hich arise regarding the admission, transfer and/or discharge of patients from the IMC and
placement priorities that cannot be adequately resolved by the parties involved should be promptly referred
to the Nurse Manager and/or Cardiovascular Medicine (CVM) Medical Director , the Director of the Access
Center, and the Director of Heart and Vascular Services.

VI. COORDINATION

Author(s): Nurse Manager, Medical Cardiology
Senior Management Sponsor: SVP, Patient Care Services and Chief Nursing Officer
Review ers: Director, Heart, Vascular, and Thoracic Service Line; Clinical Nurse Specialist, Cardiology;
Medical Director, Cardiovascular Medicine
Approval committees: Critical Care Coordinating Committee; UW Health Clinical Policy Committee
UW Health Clinical Policy Committee Approval: February 16, 2015

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.

VII. APPROVAL

Ronald Sliw inski
UWHC President and CEO

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

VIII. REFERENCES

UWHC policy #7.15, Discharge Planning Process
UWHC policy #8.31, Guidelines for Hospital Location Specif ic Administration of IV Medications
UWHC policy #7.04, Inter-hospital Transfer/Direct Admissions Policy
UWHC policy #8.88, Hand-Off Communication
Pharmacy Departmental Policy #3.20 Inpatient Hand-Off Communications

IX. REVIEW DETAILS
Version: Revision
Next Revision Due: May 7, 2018
Formerly Know n as: Hospital Administrative policy #7.21