Do You Have Admitting Privileges?

Discussion in 'Emergency Medicine' started by docB, Sep 13, 2007.

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  1. docB

    docB Chronically painful Moderator Emeritus Lifetime Donor 10+ Year Member

    The thread about EM cardiology fellowships and all the others about critical care and other inpatient specialties got me thinking about this. I do not have admitting privileges. No doc in my group can admit a patient to our own inpatient service. In fact, if we want to write orders on an inpatient we need to be able to justify it as an “emergent consult.” We like it this way as it keeps admitting docs from trying to get us do to all their procedures (they think that because we’re in house we should be their interns).

    Is this the same everywhere? Does anyone here have admitting privileges?
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  3. Apollyon

    Apollyon Screw the GST Lifetime Donor 10+ Year Member

    Nov 24, 2002
    No, and, in fact, I'm not credentialed by the hospital system for inpatient care. This is a card we can play (but still lose the hand) on the geri-psychs that board in the ED.
  4. spyderdoc

    spyderdoc Moderator Emeritus Lifetime Donor 10+ Year Member

    Jul 30, 2002
    SF Bay Area
    In the FFS arena, I love it when an admitting doc calls me up to go tube someone or start a line. Usually these pts are insured and it is an easy few bucks. We also go to all the code blues. All we do is dictate a procedure report or a :code blue summary", send a copy to our billing company, and it is amazing how much they bill for these....

    Also, by helping these guys out in the middle of the night, it helps them "like us" more and would back us up if someone came in and tried to take our contract....

    As far as admitting priveleges, we are allowed to write holding orders to get people out of the ED, but most of us dont because we don't want the liability of a patient on the floor without the admitting doc having some involvement in the case....
  5. docB

    docB Chronically painful Moderator Emeritus Lifetime Donor 10+ Year Member

    We do the codes and the tubes. Yeah the billing is good on those. We don't do the lines unless it's really emergent because we'd be doing nothing but lines on the floors. We do write the initial admitting orders because it's the culture here and our senior directors aren't interested in fighting it. When we do that we admit the patient to someone else's service, not our own.
  6. spyderdoc

    spyderdoc Moderator Emeritus Lifetime Donor 10+ Year Member

    Jul 30, 2002
    SF Bay Area

    Gotcha. I don't mind so much doing the holding orders, but since all the other guys do not like to do them, I haven't been as well....I like it in that it gets the pts out of the ER much quicker....

    As far as lines go, we really don't get called much at all...Usually it is in the middle of the night when no one else is around to do them....
  7. txterp98

    txterp98 10+ Year Member

    Dec 1, 2006
    Austin, TX
    We have admitting privileges at my hospital. I've seen a few guys in our group sometimes change a patient's status to observation admit to their service when a patient is awaiting a transfer to a psych facility and the wait is going to be a few hours. Typically, the hospitalist won't admit these patients and the guys in our group are concerned about their ER times. Ultimately when the patient leaves the ER, the doc who got the signoff has to write DC to <name of psych hospital> on the orders. Most of us don't do this and I'm not sure what ramifications it has on billing.
  8. DocZ

    DocZ 5+ Year Member

    Nov 27, 2006
    Aside from admitting you your own service, I wonder how many docs work in departments that have holding orders that allow admitting to some admitting doc's service. I have been at places where a pt can not be admitted and sent upstairs until the admitting doc or team see the pt and write the orders. On the other hand, I am at a place now where there is HUGE pressure Re: throughput and times, and if the admitting doc or team can't get down to see the pt, they go up with holding orders. This seems troubling b/c most of these pt's go with very limited orders and could sit on the floor for hours.
  9. roja

    roja 7+ Year Member

    Oct 20, 2003
    NYC--->San Francisco
    We have direct admitting privilages. Occasional turf wars happen (you can imagine which services try to dump on which services) but ultimately, no one is allowed to refuse and admission in our hospital if we decide the patient needs to be admitted. I have only had to do this once: if you don't want the patient admitted to your service, then you need to come in and write a note stating that you are refusing the admission.

    Patient went upstairs.

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