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Admission and Discharge Criteria for IMC Status on the Cardiothoracic Surgery and Transplant Unit (Acuity Adaptable Unit) (2.1.34)

Admission and Discharge Criteria for IMC Status on the Cardiothoracic Surgery and Transplant Unit (Acuity Adaptable Unit) (2.1.34) - Policies, Clinical, UW Health Clinical, General Care and Procedures, Admission, Discharge, Transfer

2.1.34


UW HEALTH CLINICAL POLICY 1
Policy Title: Admission & Discharge Criteria for IMC Status on the Cardiothoracic
Surgery and Transplant Unit (Acuity Adaptable Unit)
Policy Number: 2.1.34
Category: UW Health
Type: Inpatient
Effective Date: October 20, 2017

I. PURPOSE

To ensure the appropriate utilization of the Intermediate Care beds located on the Cardiothoracic Surgery
and Transplant Unit.

II. DEFINITIONS

AAU-Acuity Adaptable Unit

III. POLICY ELEMENTS

IMC Status on the Cardiothoracic Surgery and Transplant Unit is designed to care for the adult patient who
fails to meet criteria for admission to ICU status or the General Care floor. These patients are
hemodynamically stable, but require frequent monitoring for early recognition and treatment of potentially life
threatening events. Priority for admission to IMC status is given to the Cardiac Surgery, Thoracic Surgery,
Ventricular Assist Device, Heart Transplant, and Lung Transplant population. IMC bed availability may be
limited by the total cardiothoracic and transplant population on the unit. It is the responsibility of the
admitting service to care for patients admitted to the unit.

IV. PROCEDURE
A. Admission Criteria
i. Invasive monitoring to include arterial lines and central lines to measure central venous pressure
(CVP).
ii. Unstable dysrhythmias requiring continuous monitoring of ECG and/or continuous antiarrhythmic
drug infusions as consistent with UW Health Guidelines for the Intravenous Administration of
Formulary Drugs in Adults. Within 24 hours after the antiarrhythmic is started, the primary service
will reevaluate the patient's hemodynamic status and decide if the patient can be moved to general
care.
iii. Infusion of vasoactive medications as is consistent with UW Health Guidelines for the Intravenous
Administration of Formulary Drugs in Adults that are being administered per MD order except for
Phenylephrine and Esmolol.
iv. Transcutaneous pacing for patient awaiting permanent pacemakers. Patients with epicardial wires
connected to temporary pacemakers without a native rhythm.
v. Any patient requiring monitoring of vital signs, chest tubes, urine output, respiratory status, or other
systems on a frequency of two to four hours. This could include new postoperative patients and/or
decompensation of current general care patients. If monitoring of the above items is required more
frequently than every two hours for eight hours, the patient must be ICU status.
B. Admissions 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 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
Cardiothoracic Surgery and Transplant Unit. Patient being admitted for IMC status must be seen
within 2 hours by the admitting service designee.
ii. As census permits, the Cardiothoracic Surgery and Transplant Unit may accept patients on IMC
status for other services in the event that beds are not available in the ICU/IMC that would usually
admit those patients. In these cases, the admission and discharge policies in place for the ICU/IMC
unit that would usually manage these patients at the IMC level will apply. (For example, patients
usually admitted to TLC for IMC level care would follow TLC Admission and Discharge policies for
IMC patients.)
C. Transfer Criteria to General Care Status



UW HEALTH CLINICAL POLICY 2
Policy Title: Admission & Discharge Criteria for IMC Status on the Cardiothoracic Surgery and Transplant Unit
(Acuity Adaptable Unit)
Policy Number: 2.1.34

i. Resolution of issue requiring IMC status.
ii. Ability to safely monitor the patient under general care status.
D. Discharge. When direct discharge from Intermediate Care status on the Cardiothoracic Surgery and
Transplant Unit is appropriate, it will be completed according to current UW Health policy. (See UW Health
clinical policy #2.1.25, Discharge Planning Process).
V. CONFLICT RESOLUTION

Conflicts which arise regarding the admission, transfer and/or discharge of patients and placement priorities
that cannot be adequately resolved by the parties involved should be promptly referred to the Medical
Director, Cardiothoracic Surgery and Transplant Unit for resolution.

VI. COORDINATION

Author: Manager, Cardiothoracic Surgery and Transplant Unit
Senior Management Sponsor: SVP/Chief Nurse Executive
Reviewers: CNS, Cardiac Surgery; CNS, Thoracic Surgery; Director, Heart, Vascular and Thoracic Care
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.

VII. APPROVAL

Peter Newcomer, MD
Chief Clinical Officer

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

VIII. REFERENCES

UW Health clinical policy #2.1.25, Discharge Planning Process

IX. REVIEW DETAILS

Version: Revision
Last Full Review: October 20, 2017
Next Revision Due: October 2020
Formerly Known as: UWHC policy #7.50