Unfortunately, we are often limited in direct admitting patients due to the hospital being full, and concerns about direct admitting someone who is unstable who may not arrive until many hours later.

I. Who can be direct admitted:

Patients who are safe to wait at home or in clinic until there is a bed available, which averages 4-12 hrs for floor patients, but can get much longer when the hospital is full.  If there is not immediate bed available or the wait will be too long you may need to send patients through the ED.

II. Process

1. Outpatient provider contacts PALS to speak with the Family Medicine Inpatient Attending on call (PALS line 505-272-2000).

2. Discussion between outpatient provider and PALS attending about whether pt is appropriate based on above criteria. All patient bed placements will be arranged through PALS.

--Please be sure to clarify with PALS if admission should be Observation status or full admission, and if the patient will need isolation precautions.

3. Inpatient Attending writes down pt MR, place a phone or inpt note in the chart documenting the conversation. 

4. Outpatient (referring) provider please make sure there is an provider note so the info will be in the computer asap.  This isn't an H&P, just a clinic note.  If you are at IHS or 1st choice, please send info with the patient if possible.

5. Inpatient attending will coordinate with PALS (on the phone) who will enter the bed request and page the Family Medicine admitting pager (951-0534) when the pt arrives.  If the clinic may close soon, speak about how long it will take to get the pt a bed so that can be taken into account.  This may mean a decision again about whether the pt should go home or the ED if the clinic closes before a bed is available.

6. Accepting attending communicates info about pt to their resident.  Admitting resident passes that info on to overnight resident if the pt does not arrive prior to the end of the shift.

7. Accepting attending types brief inpatient provider progress note (can just be a couple sentences) about the pt, including referring provider name, diagnosis, initial workup to be done, etc.