RuralEDDoc

5+ Year Member
Oct 1, 2014
90
52
Status
Attending Physician
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.
 

brk81144

Attending
Apr 10, 2014
68
50
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

Semper Ubi Sub Ubi
15+ Year Member
Nov 6, 2003
989
259
The Windy City
Status
Attending Physician
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
 

CopToEM

Livin' the Dream
5+ Year Member
7+ Year Member
Jun 3, 2009
1,362
46
Southeast US
Status
Medical Student
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

Don't worry. I've got my towel.
7+ Year Member
Feb 23, 2010
1,324
1,895
Status
Attending Physician
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

Member
Lifetime Donor
15+ Year Member
May 3, 2004
1,931
1,321
Status
Attending Physician
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

10+ Year Member
Dec 27, 2008
76
34
Status
Resident [Any Field]
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.