Holding Orders

[RuralEDDoc]

Who writes holding orders to get patients admitted quickly to the floors?
Do you like or dislike having the ability to do this?
What are some of the challenges you face related to holding orders?

I ask this as patients in my ED sit for over an hour, with no movement towards the inpatient side, while we wait for the hospitalist to write admission orders. This increases LOS by an average of one hour beyond what is necessary. We're considering holding orders so that an inpatient bed can be prepared while the hospitalist completes his/her evaluation. Thanks for your input.

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[brk81144]

We place a bed order after talking to the hospitalist so that a bed can be arranged quickly. We don't have to write any other patient specific orders though so it's nice

 

[Daiphon]

We place a bed order after talking to the hospitalist so that a bed can be arranged quickly. We don't have to write any other patient specific orders though so it's nice

As do we... bonus is that admitted patients go into a "virtual unit" once the bed request is placed. As such, our LOS stops at the second that's put in, regardless of how long the patient is ultimately physically in the ED.

Our LOS numbers don't take a hit, and we have better data on boarding (which helps us & our nurses).

Win-win.

-d

 

[southerndoc]

We write bridge orders for some patients and send others to a CDU that's physically outside the ED. Frees up beds quickly.

 

[CopToEM]

As do we... bonus is that admitted patients go into a "virtual unit" once the bed request is placed. As such, our LOS stops at the second that's put in, regardless of how long the patient is ultimately physically in the ED.

Our LOS numbers don't take a hit, and we have better data on boarding (which helps us & our nurses).

Win-win.

-d

This is exactly how it works in the ED I'm in right now. Seems to work a lot better than other places I've been.

 

[BoardingDoc]

We write holding orders in our ED. Bed requested --> medicine accepts signout --> we put in holding orders --> patient is seen on the floor by the medicine resident when they arrive and they write formal admission orders.

 

[Groove]

We do bridging orders. Yes, it's a pain in the ass but it does get the pt out of the ED faster. The problem I have is that they don't drop off for 10 hours. It's somewhat of a nebulous gray zone as far as who is taking care of the pt once they leave the ED and the hospitalist has not seen them, yet they are being managed by your ED orders upon arrival to floor. I have a notify physician/nursing communication order that states something to the effect of "call admitting physician upon arrival to floor for bedside eval of pt and review/amendment of current bridge orders", etc..

 

[kmb1908]

I also write bridging orders....much different from where I trained. The hospitalist or NP would come down to the ED and see the patient and put in orders.