SCOPE: Bed Control, All Clinical Areas, Medical Staff, Nursing Services

POLICY TITLE: Admission of In-Patients
Department: Bed Control, Nursing, Physician / Policy Number:A-02-f
History of Review/Revision Dates: Est. 6/78
10/99, 10/02, 02/05, 1/10 / Effective Date:2/2012

SCOPE: Bed Control, all clinical areas, Medical Staff, Nursing Services.

PURPOSE: Outline primary services of inpatient nursing units.

STATEMENT OF POLICY: The patient will to be admitted to the hospital in an appropriate manner.

DEFINITIONS;

In Penrose-St. Francis Health Services, growth and development needs are classified by the following:

*Premature – Less than 37 completed weeks gestation.

*Late Preterm- Babies born between 34.0-36.6 weeks gestation.

*Neonate– Birth to 30 days

*Infant – Greater than 30 days to less than 1 year

*Child – Greater than or equal to 1 year to less than 12 years

*Adolescent – Greater than or equal to 12 years to less than 18 years

*Adult -- Greater than or equal to 18 years to less than 65 years

*Geriatric-- Greater than or equal to 65 years

PROCEDURE:

A.Admission OF PATIENTS

1. Patients are admitted to the hospital on the order of a physician. The physician will direct all admissions through Bed Placement at 719-776-5732.

Exception: Birth Center and NICU patients will be admitted directly to the Birth Center or NICU as appropriate.

Exception:The Eleanor Capron Inpatient Rehabilitation Unit (8th floor) patient will be admitted directly to the unit after a formal approval process dictated by the Centers for Medicare & Medicaid (CMS) and verification of a health benefit.

1. The parties arranging admission will confer with Bed Placement at 719-776-5732 regarding appropriate placement of the patient being admitted.
2. The scope of care for each unit outlines appropriate types of admissions for that unit. The patients will be admitted to the appropriate unit whenever possible, a bed or staff shortage may dictate admission to another unit.

Exception:The Eleanor Capron Inpatient Rehabilitation Unit (8th floor) is a DRG (Diagnostic Related Group) exempt unit requiring strict compliance with CMS IRF PPS (Centers for Medicare and Medicaid Services Inpatient Rehabilitation Facility Prospective Payment System) criteria for an acute inpatient rehabilitation program. During a bed shortage, the same formal admission process will be followed before a patient can be admitted to this unit; an exception would be a designated local, regional or federal disaster.

1. When the admitting criteria are not met, the clinical manager (or designee) discusses appropriate patient placement with Bed Placement at 719-776-5732 and the physician.
2. Bed Placement at 719-776-5732, in collaboration with the nursing unit will handle all room assignments during regular office hours. After hours the administrative nursing supervisor will assign the unit and patients will be registered by the emergency registration staff. All areas (ER. PACU, OR, etc.) and physicians are to call Bed Placement at 719-776-5732 or the supervisor after-hours for unit assignment. The following process is used in determining unit assignment between 0600-1800 on weekdays.

a.Bed Placement at 719-776-5732 is called when there is an admission from ER, physician’s office, or another facility.

-admission criteria are reviewed for unit placement

-Bed Placement at 719-776-5732 calls unit for room assignment

-if room is available then room is assigned

-if room not available then additional units are called as indicated by overflow process

-after hours and on weekends, the administrative nursing supervisor acts as Bed Placement at 719-776-5732

b.The overflow process is as follows

-admit to appropriate unit which matches with the patient diagnosis.

-if most appropriate unit is not available: medicals are admitted to next available medical bed (4 and 5 at PH) and surgicals to the next available surgical floor (7, 9, and MOS at SFMC)

Exception:The Eleanor Capron Inpatient Rehabilitation Unit (8th floor) will follow CMS admission criteria. an exception would be a designated local, regional or federal disaster.

-if beds continue to be scarce, then admit to any unit with an open bed where competent staff are available — patients will be transferred to most appropriate unit after beds are emptied

-specialty units, such as ED, Critical Care Unit, Amb. Care, and RCU, will hold patients as appropriate.

c.In the event of a patient who is going directly to surgery for an emergent/urgent procedure the following process will be used if the patient is to be admitted:

-the ED calls Bed Placement at 719-776-5732 for an assignment of room

-Bed Placement at 719-776-5732 assigns room and discusses with charge nurse

-patient goes to PACU after surgery and then to assigned unit

-during off hours and the weekends, the administrative nursing supervisor will follow the above process

1. Complete the Patient Admission Screening Assessment form.

Exception:The Eleanor Capron Inpatient Rehabilitation Unit (8th floor) will complete the necessary IRF documentation in the CIS or backup form for all patients admitted to this rehab program.

ADMISSION CRITERIA FOR INPATIENT NURSING UNITS

This criterion is based on each Unit’s Scope of Care and describes the most common types of patient treated on that unit.

St. Francis Medical Center (SFMC):

5th Floor Orthopedic / Surgical Unit / Adult patients primarily with but not limited to the following illnesses/procedures;

All official Centura Health and Penrose St. Francis Health Services policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained.

Admission of In-PatientsIDP A-02-f Page 1 of 5

Abdominal/Vaginal Hysterectomy

Cholecystectomy/Laser Cholecystectomy

Orthopedic Surgery

Total Joint Replacement

Gynecological Diagnoses

Adult Fracture

Abdominal Pain

Appendectomy

Bowel Resection

All official Centura Health and Penrose St. Francis Health Services policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained.

Admission of In-PatientsIDP A-02-f Page 1 of 5

5th Floor North Surgical Unit / Adult patients primarily with but not limited to the following illnesses/procedures;

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General OB and surgical

ENT

Orthopedic

Renal

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5th Floor South Medical Cardiac Unit / Adult patients primarily with but not limited to the following illnesses/procedures;

Chronic Obstructive Pulmonary DiseaseGI Bleed

Congestive Heart FailureDeep Vein Thrombosis

CAD Pneumonia

Adult Critical Care Unit (CCU) / Patients who require intensive nursing care for primarily the following illnesses:

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Myocardial Infarction

Complicated PTCA (Percutaneous trans luminal coronary angioplasty)

Unstable Angina

Pulmonary Edema

Arrhythmia with Hemodynamic Compromise

Overdose

Gastrointestinal Bleed

Renal Failure

Respiratory Failure

Shock - Sepsis

CVVH – continuous veno venous hemofiltration

Multi-system organ failure

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Birth Center: Labor & Delivery/Mother-Baby/Well-Baby Nursery / Female patients of childbearing age who require antepartum care, who are in labor, or who require postpartum care, outpatient testing, outpatient evaluation, or gynecologic care, newborn infants requiring transitional and well baby care.
NICU / Newborn infants requiring Level IIIa Neonatal Intensive Care,
Pediatrics / Pediatric and adolescent patients up to 19 years of age, primarily with but not limited to the following illnesses/procedures;

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Asthma

Pneumonia

Croup

Abdominal Pain

Appendectomy

Gastroenteritis

Bone Fracture

Joint Repairs

Ligament/Muscle Reconstruction

Tonsillectomy and Adenoidectomy, if requiring inpatient stay

RSV

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St. Francis Health Center:

3-East Psychiatry
(Adult) / Patients with acute psychiatric illness or patients who require detoxification from alcohol or drugs.

Penrose Hospital:

11th Floor / Oncology

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Head and neck post surgeries with a history of cancer

Mini trachs post-op

HIV

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9th Floor SurgicalPatients primarily with the following post-op conditions/procedures:

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Cholecystectomy

Laproscopic Cholecystectomy

Gastric Bypass

Bowel Resection

TURP Urological Surgeries

Appendectomy

Trauma injuries

Post surgery GYN (check with unit)

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8th Floor Rehabilitation
Eleanor Capron Inpatient Rehabilitation Unit / Patients recovering primarily from the following illnesses/procedures, requiring an IP level of medical care and intensive rehabilitative needs:

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Head injuries

Spinal Cord injuries

Neurological Diseases

Cerebral Vascular Accident

Limb Amputation

Polyarthritis

Orthopedic Injuries or Joint Surgery/Post Total Joint Replacement

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Or other qualifying diagnoses and co-morbidities based on CMS criteria.

7th Floor Orthopedics
Neurology / Patients primarily with orthopedic and/or neurological post surgery:
Adult Fractures / Osteo-arthritis / Rheumatoid Arthritis
Degenerative Joint Disease / Total Joint Replacement / Microdiskectomy
Spinal Fusions / Repair of Fractures / Trauma Injuries
Ant/Post Fusions / Brain Tumors / Cerebral Aneurysms
Cervical Fusions / Lumbar Laminectory/Fusions / Hand/Wrist/Shoulder Surgeries

5th Floor Renal/Diabetic Patients primarily with the following illnesses:

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Renal Disease

AV graft revisions

CAPD (Continuous Abdominal Peritoneal Dialysis)

Diabetes Mellitus

Hemodialysis and Peritoneal Dialysis

Other illnesses:

Frail elderly with multiple comorbidities

Gl Bleed

Deep Vein Thrombosis / Pulmonary Emboli

Pneumonia

Infectious Diseases

COPD (Chronic Obstructive Pulmonary Disease)

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4th Floor Medical/SurgicalPatients primarily with the following diagnoses/procedures.

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G.I. Bleed (Gastrointestinal Bleed)

Deep Vein Thrombosis / Pulmonary Emboli

Respiratory Illness

COPD (Chronic Obstructive Pulmonary Disease)

CVA / TIA

Pneumonia

Infectious Diseases that require negative pressure rooms (i.e. Tuberculosis)

Frail elderly with multiple comorbidities

Abdominal pain

Hypoxia

CHF

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3-E Cardiovascular Unit (CVU) – East Tower / Patients primarily with cardiac-related illnesses/procedures:

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(Ml) Post Myocardial Infarction

Coronary Artery Disease

Unstable Angina

Post Open Heart Surgery

Angioplasty (PTCA)

Cardiac Catheterization

Cardiac Stents

Cardiac drips-Vasoactive / Antiarrhythmic

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2nd Floor Critical Care Unit - East Tower

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Patients who require intensive nursing care for primarily the following illnesses:

Myocardial Infarction

Complicated PTCA (Percutaneous trans luminal coronary angioplasty)

Unstable Angina

Pulmonary Edema

Arrhythmia with Hemodynamic Compromise

Overdose

Gastrointestinal Bleed

Renal Failure

Respiratory Failure

Open Heart Surgery

Shock - Sepsis

Trauma and Trauma Related Injuries

CVVH – continuous veno venous hemofiltration

Multi-system organ failure

Complex vascular cases

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2nd Floor Bariatric Care / Back Unit (BBU) – East Tower / Patients primarily post-op bariatric procedures:

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Gastric Bypass procedures

Lap Band gastric procedures

Major back surgeries

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References:

CMS Criteria

Centers for Medicare and Medicaid Services Inpatient Rehabilitation Facility Prospective Payment System criteria

Colorado Trauma guidelines

NICU admission criteria

PSF Unit Scope of Services and Staffing Plans

POLICY VIOLATION

Any Centura associate who fails to abide by this policy may be subject to disciplinary action, including termination.

Approval Body: Interdisciplinary Practice Committee / Signature/Date: Katherine D McCord, RN, CNO 2/13/12
Secondary Approval Body: / Signature/Date: Jeff Oram Smith, MD, CMO 2/23/12

Last review facilitated by Nancetta Williams, Director Medical Staff Services

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