pathways for ed hospital admissions baptist memorial hospital-golden triangle
Post on 05-Jan-2016
22 Views
Preview:
DESCRIPTION
TRANSCRIPT
Pathways for ED Hospital Admissions Baptist Memorial Hospital-Golden Triangle
ANY TYPE AORTIC DISSECTION
Page 2
ANY TYPE AORTIC DISSECTION
CV SurgeonConsult IM or Cardiology, as
needed
ER physician has final authority for disposition of all patients.Patients admitted to Intensivists in ICU by pathway, can be referred back to primary physician upon discharge from ICU. If unreferred patient, upon discharge from ICU, refer to physician on call for unreferred on day of admission.
BMH-GT Pathways for Admission from ED
CHEST PAIN
Page 4
CHEST PAIN
ST segment elevation > than
2mm or ↑ of troponin
Patient without MI
Cardiology
If patient has known CAD
Patient without Hx of CAD/
other
Cardiology
IM/on call
BMH-GT Pathways For Admission From ED
ER physician has final authority for disposition of all patients.Patients admitted to Intensivists in ICU by pathway, can be referred back to primary physician upon discharge from ICU. If unreferred patient, upon discharge from ICU, refer to physician on call for unreferred on day of admission.
CHF in need of Admission
Page 5
CHF
Patient followed by Cardiologist
All other CHF
Admit Cardiology
Admit IM, with consult to
Cardiology as needed.
BMH-GT Pathways For Admission From ED
ER physician has final authority for disposition of all patients.Patients admitted to Intensivists in ICU by pathway, can be referred back to primary physician upon discharge from ICU. If unreferred patient, upon discharge from ICU, refer to physician on call for unreferred on day of admission.
GI BLEED
Page 7
GI BLEED
Patient without concurrent
serious medical illness.
Call GI
GI admit with IM consult, if
needed*
IM admits after discussion with
GIPatient with multiple life threatening
medical problems
IM admits with GI consult
GI calls IM if plan is to admit to IM (discuss plan for elective endoscopy, etc.).
BMH-GT Pathways For Admission From ED
ER physician has final authority for disposition of all patients.Patients admitted to Intensivists in ICU by pathway, can be referred back to primary physician upon discharge from ICU. If unreferred patient, upon discharge from ICU, refer to physician on call for unreferred on day of admission.
BRAIN HEMORRHAGE
Page 8
BRAIN HEMORRHAGE
Notify Neurosurgeon
to see
If unavailable
If available Neurosurgeon and Medical Consultants
(Critical Care or Hospitalist) will discuss case
and decide who will be admitting
physician.
*Neither will ask ED to deliver messages.
Transfer to another facility
BMH-GT Pathways For Admission From ED
ER physician has final authority for disposition of all patients.Patients admitted to Intensivists in ICU by pathway, can be referred back to primary physician upon discharge from ICU. If unreferred patient, upon discharge from ICU, refer to physician on call for unreferred on day of admission.
ISCHEMIC INFARCT - STROKE
Page 9
ISCHEMIC INFARCT - STROKE
TPA candidate *
Not candidate for TPA
Consult Neurology
Consult NeuroAdmit to IM with Neuro consult
Give TPA in ERAdmit to IM with Neuro consult
* Need proper education on administration of TPA. Until then, if Neuro is not available, bypass to another facility.
BMH-GT Pathways For Admission From ED
ER physician has final authority for disposition of all patients.Patients admitted to Intensivists in ICU by pathway, can be referred back to primary physician upon discharge from ICU. If unreferred patient, upon discharge from ICU, refer to physician on call for unreferred on day of admission.
NEW RENAL FAILURE
Page 10
NEW RENAL FAILURE
If patient requires acute hemodialysis *
Nephrology to admit
IM to admitIf hemodialysis not expected
during this admission
* Need guidelines for requirements for HD
BMH-GT Pathways For Admission From ED
ER physician has final authority for disposition of all patients.Patients admitted to Intensivists in ICU by pathway, can be referred back to primary physician upon discharge from ICU. If unreferred patient, upon discharge from ICU, refer to physician on call for unreferred on day of admission.
PNEUMONIA
Page 12
PNEUMONIA
If patient has pulmonologist
following
Admit to pulmonary
If mechanical ventilation required
If patient not followed by
pulmonologist
No mechanical ventilation required
IM to admit
Pulmonary to admit
BMH-GT Pathways For Admission From ED
ER physician has final authority for disposition of all patients.Patients admitted to Intensivists in ICU by pathway, can be referred back to primary physician upon discharge from ICU. If unreferred patient, upon discharge from ICU, refer to physician on call for unreferred on day of admission.
Respiratory Distress/Failure
Page 12
Respiratory Distress/Failure
PCO2 > 55Mental Status
ChangesExcessive work
to Breathe
Admit to pulmonary
If mechanical ventilation required
PCO2 < 55
No mechanical ventilation required
IM to admit
Pulmonary to admit
BMH-GT Pathways For Admission From ED
ER physician has final authority for disposition of all patients.Patients admitted to Intensivists in ICU by pathway, can be referred back to primary physician upon discharge from ICU. If unreferred patient, upon discharge from ICU, refer to physician on call for unreferred on day of admission.
ANY OB HOSPITALIZATION
WITH MEDICAL PROBLEM NEEDING
MANAGEMENT
Page 11
ANY OB HOSPITALIZATION
OB admitsConsult IMas needed
BMH-GT Pathways For Admission From ED
ER physician has final authority for disposition of all patients
POST-OP SURGERY
COMPLICATION
Page 13
POST-OP SURGERY COMPLICATION
Surgeonadmits
Consult IM, as needed
ER physician has final authority for disposition of all patients
BMH-GT Pathways For Admission From ED
Page 14
Admission from ED
All Renal Transplant
patients (including ortho fractures)
All Peritoneal and Hemodialysis
Patients
ED Physician has final authority for disposition of all patients.
Admit to Nephrology
BMH-GT Pathways For Admission From ED
top related