When to admit and when to discharge

[lifetime]

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Hi. Are there any books that outline the criteria required for admitting a patient. Also, when admitted, what are the criteria required to discharge. Thanks.

 

[jdh71]

Hi. Are there any books that outline the criteria required for admitting a patient. Also, when admitted, what are the criteria required to discharge. Thanks.

You admit when the ED can't figure out what to do with the patient.

You discharge when they can eat, walk, and wipe their own ass at home. If they can't do that, you discharge when you have found a place or a person that will feed them, move them, and wipe their asses.

 

[Instatewaiter]

Hi. Are there any books that outline the criteria required for admitting a patient. Also, when admitted, what are the criteria required to discharge. Thanks.

When to admit:
1) Are they too sick to go home and survive (ie new oxygen requirement, sepsis)
2) They require something that can only be done inpatient otherwise it would be life/limb treatening (IV abx, IV diuresis, IVIG)
3) Expedited workup needs to be done quickly and is easier and safer inpatient

When do discharge
1) You have turned them around enough that they can get the rest of the way better at home or at a facility

 

[lifetime]

Lol @jdh71. Thanks for the response instatewaiter

 

[inspirationmd]

You admit when the ED can't figure out what to do with the patient.

You discharge when they can eat, walk, and wipe their own ass at home. If they can't do that, you discharge when you have found a place or a person that will feed them, move them, and wipe their asses.

First part is a bit cavalier but is true in a nut shell.

Second part is gold and very very true. Rising interns take note: Dispo is king! Get SW on board the instant they hit the door or you will regret it. Keeps your census and LOS under control.

 

[Danbo1957]

Always a complicated process, that you can only really learn on the job... Not a book but a decent overview from the ER side of it:

http://www.epmonthly.com/whitecoat/2011/07/to-admit-or-not-to-admit-that-is-the-question/

 

[Instatewaiter]

Just some observations I've had over the last few years as to why the ED and most inpatient services don't get along in academic medical centers:

1) ED is worried about dispo first and foremost, mainly because they have a truckload patients to sort through in their waiting room and need to make sure they don't have someone dying there.

2) When the ED calls, it means more work for the hospital service. No one likes that. In academic medicine this is met with groans. In private practice, it is the lifeblood of the specialist. Don't get into the habit of groaning... it is a hard habit to break.

3) ED has to work fast with little info. It is easy to look back at the data and synthesize what was going on from the beginning. Hindsight is 20/20. I mean 3 liters of fluid to the guy with advanced heart failure sounded like a good idea at the time (i kid, i kid)

4) ED docs seem to be more risk averse. I don't know if it is because they get sued more or they hear about their partner who got sued.

5) It is a sh.t show in most ERs. If the floors were this kind of a madhouse, I think everyone in IM would quit.

 

[rokshana]

Just some observations I've had over the last few years as to why the ED and most inpatient services don't get along in academic medical centers:

1) ED is worried about dispo first and foremost, mainly because they have a truckload patients to sort through in their waiting room and need to make sure they don't have someone dying there.

2) When the ED calls, it means more work for the hospital service. No one likes that. In academic medicine this is met with groans. In private practice, it is the lifeblood of the specialist. Don't get into the habit of groaning... it is a hard habit to break.

3) ED has to work fast with little info. It is easy to look back at the data and synthesize what was going on from the beginning. Hindsight is 20/20. I mean 3 liters of fluid to the guy with advanced heart failure sounded like a good idea at the time (i kid, i kid)

4) ED docs seem to be more risk averse. I don't know if it is because they get sued more or they hear about their partner who got sued.

5) It is a sh.t show in most ERs. If the floors were this kind of a madhouse, I think everyone in IM would quit.

yes, but I've heard the quote " i don't care where the pt goes so long as they leave my ER"…
IMHO those older EM docs look at trying to get the person home as the goal…if they can't fix them, then they admit…the younger ones seem to just want to triage them out (and don't get me started on the VA ones…) and sometimes the easier thing is to just admit them.

 

[DermViser]

Just some observations I've had over the last few years as to why the ED and most inpatient services don't get along in academic medical centers:

1) ED is worried about dispo first and foremost, mainly because they have a truckload patients to sort through in their waiting room and need to make sure they don't have someone dying there.

2) When the ED calls, it means more work for the hospital service. No one likes that. In academic medicine this is met with groans. In private practice, it is the lifeblood of the specialist. Don't get into the habit of groaning... it is a hard habit to break.

3) ED has to work fast with little info. It is easy to look back at the data and synthesize what was going on from the beginning. Hindsight is 20/20. I mean 3 liters of fluid to the guy with advanced heart failure sounded like a good idea at the time (i kid, i kid)

4) ED docs seem to be more risk averse. I don't know if it is because they get sued more or they hear about their partner who got sued.

5) It is a sh.t show in most ERs. If the floors were this kind of a madhouse, I think everyone in IM would quit.

Considering that EM has a relatively controlled lifestyle when it comes to actual work time - set number of shifts per month, set number of time per shift per month, it's not at all surprising that inpatient services, such as IM and Surgery, that don't have this luxury, don't get along with the ED. As far as 1) they can truly prioritize who they see.

That being said, EM does have a very high burnout rate.