Do you admit your patients primarily??

[347932]

Here's the issue.

Many of the patients that end up going into the hospital through my office end up that way because they have nasty diabetic foot infections and are generally pretty sick when I see them.

In my area I have two choices. Either primarily admit these patients under my service (which I may or may not have a resident helping me with) or through the ED, since the hospital has hospitalists that do the inpatient care.

I'm not crazy about primarily admitting patients, as I've been less than happy with how these admissions go and how timely the hospitalists get around to seeing these sick patients. I find they get faster, better care if they go through the ED.

The problem I run into is that even though I personally call the ED and tell them the patient is on the way and give them all my contact information (which they have in the system anyway), and send my patient to the ED with my business card with my personal cell phone hand written on the back, its a 50/50 shot of whether the hospital calls me or on of my colleagues unaffiliated with my practice. Even when my patients ask for me by name.

I think I may have to shift my paradigm and just start primarily admitting these people so I don't lose them. Any thoughts?

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[Podfather]

Here's the issue.

Many of the patients that end up going into the hospital through my office end up that way because they have nasty diabetic foot infections and are generally pretty sick when I see them.

In my area I have two choices. Either primarily admit these patients under my service (which I may or may not have a resident helping me with) or through the ED, since the hospital has hospitalists that do the inpatient care.

I'm not crazy about primarily admitting patients, as I've been less than happy with how these admissions go and how timely the hospitalists get around to seeing these sick patients. I find they get faster, better care if they go through the ED.

The problem I run into is that even though I personally call the ED and tell them the patient is on the way and give them all my contact information (which they have in the system anyway), and send my patient to the ED with my business card with my personal cell phone hand written on the back, its a 50/50 shot of whether the hospital calls me or on of my colleagues unaffiliated with my practice. Even when my patients ask for me by name.

I think I may have to shift my paradigm and just start primarily admitting these people so I don't lose them. Any thoughts?

Admit yourself and consult hospitalists. Or see if you can call the hospitalist directly for admission and they consult you.

 

[Feli]

...see if you can call the hospitalist directly for admission and they consult you.

That seems like the logical solution to me. Direct admits are the way to go. The patients probably have a PCP, so call them if they're on staff where you need to send the patient and if they'll direct admit the pt. If they're not on staff there, call one of the hospital's IM/FP doc you like and see if he'll accept a direct admit. The patient will have a room reserved, med doc in the loop, basic key admit orders like abx/fluids/diet/etc called in, etc by the time they get there... and you're almost surely gonna get consulted on the admit orders.

ER admits seem to be a dice roll and waste pt/payer money. The patient waits and rots in the ER for awhile, and there's a lot of things that can get lost in translation between the ER staff, ER docs, etc. You will probably get the med doc on call for admits, might not get consulted if he doesn't know/like you, etc. Even if the ER doc takes the time to find out the pt's PCP and admit to them, you still might not get consulted if you didn't touch base with them and they aren't familiar with you. If the pt has no insurance and the ER is your only choice, then I guess that's your last resort, though.

I don't see why you'd ever direct admit them to yourself... med docs do that for a living (their high ticket items are those high level H&Ps), they are just more skilled and practiced than we are at medical mgmt, and they have house officer and/or residents to manage the admit 24/7. About the only pts I'd admit to myself would be non-peds ASA 1 pts who are 23hr for post-op observation (and still consult their PCP for med mgmt).

 

[PADPM]

We used to admit to our service more, but now we utilize the hospitalist and call ahead and we get the consult. However, at our primary hospital our group gets 99% of the consults anyway, so we rarely ever get "screwed" if the patient happened to go through the ER and slipped through the cracks or didn't mention our name, etc.

It just seems easier, quicker and more efficient to utilize the hospitalist. And the absolute BEST part is that we don't have to dictate a discharge summary

 

[jonwill]

I usually admit my own patients. If they are a complete trainwreck, I'll consult medicine.

 

[krabmas]

I'm in a multi-specialty group that is the main presence in the hospital we send patients to. So I'll admit patients to me if they are ASA 1 or 2 or if it is overnight post-op. If I have any concerns I'll at least consult medicine.

In residency we would get patients through the ED all the time. One of the 1st questions we always asked was if the patient had a podiatrist. If not, the attending on call was called. If the patient had a podiatrist we called that podiatrist, even if they seldom came to our hospital.

I'm not sure I understand why you are loosing these patients. When you call the ED, you can ask who the hospitalist on-call is, call them, and let them know you are sending a patient for admission and would like to continue to see your patient in the hospital. Maybe this will help?

 

[347932]

Thanks for the input everyone. I've had some communication with the Director of Medical Staff in the last day or so, and have figured out a fool proof way of getting this done so everyone is happy.

I certainly appreciate the recommendations and hopefully I'll avoid this situation in the future.

 

[krabmas]

Thanks for the input everyone. I've had some communication with the Director of Medical Staff in the last day or so, and have figured out a fool proof way of getting this done so everyone is happy.

I certainly appreciate the recommendations and hopefully I'll avoid this situation in the future.

can you share, so that maybe if one of us does have a problem in the future we can learn from you?

 

[347932]

can you share, so that maybe if one of us does have a problem in the future we can learn from you?

Sure!

The biggest issue lately with the hospitalists has been the huge amount of turnaround, so even if I made contacts with a few of them they would disappear quickly and I'd have to start all over again. I failed to mention that my first post, but I guess that was rather important. This became very time consuming when every three months I'd have to start all over again.

I exchanged e-mails with the director of the ED and the Director of the Medical Staff, who I've known for about ten years, and we agreed on a protocol where even if I do send them to the ED, the same hospitalist group would be contacted on my behalf (just in case I can't reach them myself), and then the lines of communication would be open. I've been assured that this group has a much more stable staff than the others. I will, however, try to contact them first to have them directly admit my patient and contact me immediately upon admission to save the cost of an admission through the ED.

One of the issues that crops up with my direct admissions in the long time past, was that the hospital prefers that whoever admits the patient does the initial admission full H&P and even though we are still fighting for privileges to do this still, we don't currently and didn't have the priviliges to do this at the hospital, which is the biggest hospital in our area and where I do all my cases.

 

[Foot Doc]

I admit my own patients as the primary and consult the appropriate services.