Non-elective Admissions
Patient Eligibility
- Direct admission patients will be from practices that have admitting privileges at MGH and these patients will bypass the ED.
- They need to have been seen by the admitting practice on the day of admission.
- Patients must be clinically stable, not in need of O2, immediate IV fluids, or immediate antibiotics. Patients with chemotherapy related fever and neutropenia who are not septic are exempt from the above guidelines. All other patients who need these kinds of interventions must go through the ED. If there are any questions as to whether or not the patients need to go through the ED, the case should be discussed with the pediatric senior resident.
- As a general guideline, direct admissions should arrive before 4:00 p.m. to assure the best communication between the admitting physician and admitting team.
Process for the Referring Physician
- Call the admitting Senior resident to discuss the patient and plans. If you do not know who is the Senior admitting resident, then check the On Call Directory of the Partners Telephone Directory or call the MGH page operator(617-726-2066).
- Call the resource nurse on the individual floor (Ellison 17: 724-5710, Ellison 18: 724-5810) to discuss the patient. The nurse will need to know the clinical status of the patient, immediate plans, and whether the patient requires isolation or special monitoring.
- Call the Mass General admitting office at 617-726-3393 with patient information, i.e. age, diagnosis, unit preference, and whether isolation or a single room is needed.
- If at all possible, an admission note and pre-admit orders on POE or a FAX of holding orders should arrive with the patient. The fax number for Ellison 17 is 617-724-5750, and the fax number for Ellison 18 is 617-724-5850.
- Advise the family that a parent will need to go down to admitting to sign forms after the child is on the floor.
Elective Admissions
These generally are scheduled by the subspecialty service prior to the day of admission.
Reminders:
- Admitting service should contact the admitting senior resident and resource nurse either the day prior or the morning of admission to inform them of the patient.
- Prior to the patient’s arrival on the floor, an admission note and pre-admit POE orders including desired labs and tests to schedule should be done. This will avoid the patient being on the floor waiting for a plan to be made or communicated to the treatment team.
- If a patient’s clinical status has changed since scheduling the elective admission, then the referring physician must see the patient on the day of admission prior to their arrival on the inpatient unit. This category might include patients with cystic fibrosis with severe exacerbations or hemoptysis, or GI bleeders with active issues. It is the responsibility of the admitting service to insure that these patients do not need emergency treatment in the ED.
Emergency Admissions
These should be handled through the 617-724-4357 (617-724-HELP) or 877-637-3337 (877-MD-REFER) lines that are in place.
Outside Referrals
Physicians without admitting privileges who need to refer in patients should go through the admitting senior resident who can help in the triage process (ED, PICU, need for Transport Team). These patients will be assigned to the Hospitalist service or an appropriate subspecialty service.
How to Transfer or Transport a Patient
Reviewed 2008, Peter Greenspan, MD
