Patients are typically admitted to inpatient settings via the Emergency Room (ER) for the admitting facility. Indeed, even transfers from outlying hospitals route via the ER in case a decision is made to return to the referring facility or to home.
Sometimes the accepting clinical service has already performed an assessment justifying admission and there are compelling reasons to bypass the ER. The admission decision may be made in clinic, a medical outpatient unit or a hospital outpatient department. Or, transfer and admission to a facility may be triggered by a protocol bypassing ER for public health (pandemic) or other reasons. In these cases, a "direct" admission workflow is followed.
Admissions via the ER, even if the patient is admitted from a triage, waiting or ambulance area are not "direct" and proceed using an admit-from-ER workflow. It may be necessary to prod ER registration to create an encounter for the patient so that admission navigation and orders can proceed.
The starting point is important. Direct admits can be from elements of the same facility (i.e., Intra-facility; e.g., clinic, outpatient department/unit) or between different facilities (i.e., Inter-facility; e.g., hospital transfer, admit to facility from non-facility clinic).
In all cases, the start of any admission process must include direct contact with an admitting service or provider; ensuring agreement to admit, agreement about who is responsible for admitting orders and documentation, and who will call facility bed management to ensure that the needed room, bed and controls (e.g., isolation) are available and reserved.
Intra-Facility Direct Admit
The exact admitting workflow depends upon whether the clinic or outpatient unit or admitting physician takes responsibility for admission orders and documentation. If the direct admit is initiated from an ambulatory clinic setting, use this tip:
If the direct admit is initiated from a Hospital Outpatient Department (HOD), the patient must be checked in to the HOD encounter (or converted by staff from a recurring HOD encounter to a non-recurring class). The admitting physician works from the active HOD encounter to place an "Admit to Inpatient" order, converting the outpatient appointment to an inpatient encounter. Although this automatically generates a bed request, it is essential that the physician or staff contact the hospital bed manager to ensure availability and reservation of the needed bed.
Inter-Facility Direct Admit
Patients accepted from other facilities (non-Connect Care) require a "Referral, Access, Advice, Placement, Information & Destination" (RAAPID) service consultation with the proposed admitting service, and a RAAPID-facilitated arrangement for receipt of the patient to an appropriate inpatient unit. RAAPID ensures that appropriate connections are effected between sending and receiving providers, as well as the receiving facility bed management. The admitting service is notified when the patient arrives and proceeds with admission orders and documentation.
If a transfer is effected without RAAPID, then the referring provider MUST contact the receiving provider and site to confirm patient eligibility and acceptance. The receiving provider contacts facility bed planning to confirm bed availability and reservation.
Depending upon arrangements between providers and whether the patient is received from a Connect Care facility, the sending provider may initiate provisional admission orders (signed and held). The accepting provider typically places the "Admit to Inpatient" order upon patient arrival, while also managing any signed and held orders that may have been placed by the sending provider.
There may be situations where a patient is seen in a Connect Care outpatient clinic and needs direct admission to a facility where Connect Care is not the record of care.
Since the admitting facility will not have the capacity to receive or act upon orders placed in Connect Care, management of the admitting communication and orders should follow whatever protocol is required by the receiving facility. For example, a paper order may be completed for submission to the facility via fax, secure email or physical transport.
Connect Care documentation should reflect the fact that the patient is being admitted to the recipient site. There is no need to replicate (e.g., scan and attach) the admission orders in Connect Care because these do not apply where Connect Care is the record of care.