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Admission and Discharge Criteria for Transplant IMC Status on B4/6 (2.1.32)

Admission and Discharge Criteria for Transplant IMC Status on B4/6 (2.1.32) - Policies, Clinical, UW Health Clinical, General Care and Procedures, Admission, Discharge, Transfer

2.1.32


UW HEALTH CLINICAL POLICY 1
Policy Title: Admission and Discharge Criteria for Transplant IMC Status on B4/6
Policy Number: 2.1.32
Category: UW Health
Type: Inpatient
Effective Date: October 20, 2017

I. PURPOSE

To ensure the use of a uniform policy when patients are admitted to and discharged from B4/6 Intermediate
Care (IMC) status.

II. POLICY ELEMENTS
Scope of Services: The Transplant IMC status has been designed to care for the adult transplant patient
who does not meet criteria for admission to the ICU or to a general care floor. These patients are
hemodynamically stable and often post operative, but require frequent monitoring to ensure optimum graft
functioning or for early recognition and treatment of serious post operative complications. Admission of IMC
status patients to Transplant (B4/6) will only be inclusive of solid organ transplant patients. It is the
responsibility of the Transplant physician, and/or designee to care for patients admitted to the unit and assist
with patient flow issues relating to admission or transfer of status criteria.
III. PROCEDURE
A. Admission Criteria: What follows are examples of patient populations who are appropriate for IMC status
admission (please note this list is not comprehensive):
i. Transplant
a. Any solid organ transplant patient requiring monitoring of vital signs, urine output,
respiratory status, or other systems on a frequency of greater than every two hours. This
could include new postoperative patients, patients in rejection, and/or decompensation of
current general care patients.
b. Delirium characterized by fluctuating level of consciousness, impaired ability to focus,
sustain or shift attention; impaired cognition (disorganized behavior, disorientation or
impaired memory) and perceptual disturbance.
c. IV immunosuppression therapy.
B. Patients not appropriate for admission to B4/6 IMC status:
i. Complicated acute MI with temporary pacemaker, angina, severe hemodynamic instability, or
severe dysrhythmia.
ii. Patients with acute respiratory failure not responding to positive airway pressure and at imminent
risk of requiring intubation.
iii. Patients requiring monitoring of pulmonary artery catheter.
iv. Patients in status epilepticus.
v. Patients from whom aggressive modalities of care are being withheld or have been withdrawn,
such that they are receiving only comfort measures.
vi. Patients who require ongoing 1:1 nursing care.
vii. Patients with severe physiologic instability requiring ICU care.
viii. Patients requiring intercranial pressure monitoring.
ix. Patients requiring vasoactive drips or other level 3 medications.
C. Admission Process
i. Patients who meet admission criteria for IMC status will be admitted upon the request of the
attending physician or designee by contacting the Nursing Coordinator. Bed availability must be
determined prior to admission. In the event that the patient volume exceeds capacity, the Nursing
Coordinator will work with the Clinical Nurse Manager, or designee, and appropriate medical
service regarding which patient(s) will be admitted and discharged from IMC status on the
Transplant Unit. Nursing Coordinator and the Transplant Medical Director or designee to evaluate
appropriateness of admission and to resolve disputes.
D. Transfer Criteria to General Care Status:
i. Resolution of issue requiring IMC status.
ii. Ability to safely monitor the patient under general care status.
E. Transfer Process:



UW HEALTH CLINICAL POLICY 2
Policy Title: Admission and Discharge Criteria for Transplant IMC Status on B4/6
Policy Number: 2.1.32

i. Patients will be reviewed by case management, medical staff or their designee on a daily basis for
appropriateness for IMC level of care.
ii. A Health Link transfer order must be submitted to transfer the patient from IMC status indicating
the service, level of care and attending physician.
F. Discharge
i. Patients may be discharged to home or an appropriate care facility directly from the IMC. When
direct discharge from the IMC is appropriate, it will be completed according to UW Health Clinical
Policy #2.1.25, Discharge Planning Process.
G. Conflict Resolution
i. Conflicts which arise regarding the admission and discharge of patients and priorities, which cannot
be adequately resolved by the parties involved, should be promptly referred to the Medical Director,
Transplant Service Line or Medical Director Surgical & Psychiatric Nursing for resolution.
IV. COORDINATION

Author: Clinical Nursing Director Surgical & Psychiatric Nursing; Outcomes Manager, Transplant
Senior Management Sponsor: SVP/Chief Nurse Executive
Reviewers: CNS Transplant & General Surgery Units; Clinical Nurse Manager, Transplant; Director,
Transplant Service Line
Approval committees: UW Health Clinical Policy Committee
UW Health Clinical Policy Committee Approval: September 18, 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. REFERENCES

- McKesson Health Solutions, LLC. (2009). InterQual Level of Care Criteria. Newton, MA: McKesson
Corporation and/or one of its subsidiaries.
- American College of Critical Care Medicine. Guidelines on Admission and Discharge for Adult Intermediate
Care Units (1998) Mar; 26(3): 607-610.
- UW Health Clinical Policy #2.1.25, Discharge Planning Process

VII. REVIEW DETAILS
Version: Revision
Last Full Review: October 20, 2017
Next Revision Due: October 2020
Formerly Known as: UWHC policy #7.06