The emergency medicine physician will see most patients who will be admitted to the Hospitalist Group in the ED and perform a history and physical examination. If the patient requires admission, the emergency medicine physician will order indicated all studies (including labs) that are central to the evaluation before calling the hospitalist.
Timing of Consult and Diagnostic Testing
The Hospitalist should be called as soon as it becomes clear that the patient requires admission. If the need for admission is clinically apparent, the study results do not have to be completed prior to calling the Hospitalist. However, if chest x-ray, ECG, or dip urinalysis are central to the evaluation, these studies should be completed prior to calling the admitting physician. If it is likely that ED point-of-care (POC) laboratory tests including bedside troponin will significantly accelerate the patient evaluation, these tests should be ordered before calling the CHG physician.
When the emergency medicine physician calls the Hospitalist, they should discuss the type of bed needed, and the ED unit secretary will place an order for the desired bed. The Hospitalist should see the patient in the ED within 30 min. In the case of stable patients, they may elect to give phone orders and see the patient on the floor.
Hospitalist Standing Orders will be kept in the ED to aid in the admission process (Attachment A). Any order designated as “STAT” or “NOW” will be carried out in the ED before the patient goes to the floor.
Transfer to Floor
If the Hospitalist agrees, stable patient may go to their room when the bed is available where they will be seen by the Hospitalist on the floor. This does not apply to patients who are going to an intensive care setting.
Patients Transferred From a Physician's Office Or Outside Hospital
Clinically stable patients who are accepted in transfer from a clinic, private office, or outside hospital should be admitted directly to a floor bed without being seen in the ED.