ED holding orders policy 8/3/09
Hello all,
This email is to inform you that a new plan is being put in place with regards to ED Holding Orders. Recently, there has been significant frustration for both ED physicians as well as Internal Medicine physicians regarding this issue. This has led to confusion regarding which patients are appropriate for ED holding orders and under which circumstances they should be placed. Both departments recently had a meeting to determine the obstacles that must be overcome to make these orders a more regular part of our admitting process due to increasing patient volumes and an increasing demand for throughput and efficiency. Therefore, effective Monday, August 3 at 7 am, the ED physicians will began putting in holding orders on every patient that meet "stable" criteria, as outlined below.
The definition of stable is as follows:
* Stable in ED for at least two hours
* Alert, capable of asking for help
* Vital signs within normal limits (for specific patient)
* ED Attending concurs patient appropriate for Holding Orders
* No active chest pain
* Initial dose of antibiotics given in Emergency Department
* Meets nursing requirements for floor or floor with telemetry
This certainly is a “work in progress” and I encourage your feedback regarding this process. Both the ED and the Internal Medicine Department have concerns about such a change, but believe that this is the best thing to improve workplace efficiency and throughput. If you believe an incident occurs where patient care is compromised by these orders, please let us know and provide the appropriate details regarding how the patient's care was compromised. We all are striving to keep patient care as our top priority and we will work hard to ensure that quality of care is not compromised as we implement these new changes.
Although this is certainly a culture change here at UNC, please be aware that this is now commonplace in many other academic centers. The administration is committed to continuing with ED holding orders in order to facilitate throughput and care for our patients in the best way that we can.
Thank you for your attention and cooperation in this manner.
Jason