Direct admit

Legacy only. This data was replaced as part of the 2016 Time and Place changes. See Previous Service field. 

This is relevant to ER Wait. There originally was a question there regarding why we collect this. I think we collect it primarily to prevent the cross-check for ER Wait from firing if there is no legitimate ER wait entry. However, if an ER bed is taken up, is that what we want to be collecting?

Direct Admissions

If a patient has been sent from a ward, ER or ICU to your hospital where the sending physician has discussed the case with the accepting physician and the accepting physician has accepted the pt to their service, this is a direct admission. These patients could still stop off in your ER, but are not seen by the ER doctors. Normally, when these direct admit patients arrive in ER, the accepting physician or service will be paged by ER and they will go down to assess the patient there and arrange for the pt admission. (this is usually the case with patients sent form other hospital ER's or wards). Patients that require ICU care and the ICU physician has accepted them will usually go directly to the ICU (without stopping in ER)

Clarification for TMP "ER Wait" category "Direct Admit" (medicine program only)

To use the ER WAIT (ER ADMIT)in the TMP section, the pt must have been located in your hospital ER.. ("admit from" must be ER of own hospital)

• To use the ER WAIT (DIRECT ADMIT) in the TMP section, the pt must have come from another location (other than your own hospital ER) The "admit from " must be anything but your own hospital ER. This setting means that the pt came usually from another hospital and the sending physician has already discussed the pt with the medicine doctor at the receiving hospital. The medicine doctor has already agreed to accept the pt to their service. The pt goes to ER because they need to still wait for a medicine bed, but the pt has been accepted by the medicine service on arrival. The ER doctors do not see these patients so they are "direct admit" under ER waits.
• See ER Wait
• If there is not a delay in moving a pt from one hospital to another in the setting of a direct transfer, then there is no need to use the ER wait at all. Just put it in as a transfer from that facility. The ER wait is only for delays where the pt must wait for a bed in ER.

Direct to Medicine ward from Ambulatory Care

DIRECT to Medicine are patients who the medicine service attending Dr. has already accepted to their service, but the patient is sent to the ER to wait for a ward bed.

Example of Direct to medicine from ambulatory care clinic: Admit FROM: HA Registry Admit date: Medicine service Accept date (date and time admitted to medicine service): is the date and time patient came to ER ER Wait Tmp entry: the date and time patient actually arrived on the ward Comment type in as follows: parked in ER

If a patient is sent to ER from ambulatory care to be assessed by Medicine Service in ER to see if he should or should not be admitted to a med ward bed, then this is not a direct admission to medicine. Admit from is HE.

NOT direct Admits

eg Stroke 25s to HSC ER from home

When a patient comes in as a stroke 25 to HSC ER from home, we are to code it as an ER Wait: ER Admit in Temp Studies,and admission is not to be considered a "Direct" from home. Admit time is as usual on MD admit sheet.--PStein 13:44, 2015 July 23 (CDT)