Disagreements regarding the appropriate service for admission should be resolved at the attending level. If still unresolved, the Clinical Affairs on-call physician for Family Medicine and the Section Chief for the Pediatric Hospitalists should be involved promptly to resolve any disputes.

The following are only guidelines and the patient’s best interest should be the primary factor in determining the appropriate service.

Consultation needs not addressed in these guidelines may be requested anytime. Consults should be carried out in a timely and professional manner with written and verbal communication of attending approved recommendations within 12 hours of the request unless otherwise agreed.

Communication is vital to good patient care. When there are no new consultant recommendations, then communication via clear progress notes is acceptable. Any change in recommendations by the consulting service must be clearly documented and communicated.

If a patient’s ongoing reason for admission changes during the hospitalization, the primary and/or consulting service should be determined by this guideline.

Transfers of care will be agreed at an attending-to-attending level and accompanied by an interim summary for patients hospitalized >48 hours and an appropriate verbal sign-out. The patient is the primary responsibility of the existing team until sign out is completed and transfer orders are written. Patients who are expected to be discharged within 24 hours should stay on the admitting service to ensure improved continuity for discharge.

Any pediatric patient who requires the following treatment:

Any pediatric patient who is trach dependent or vent dependent.

Any pediatric patient with concerns for or diagnosis of the following:

Any patient with new or existing renal disease that requires acute management.

Any patient with concerns for malignancy.

Any patient with abusive head trauma resulting in a cranial or intracranial injury.

Any patient with an eating disorder as the primary diagnosis requiring inpatient admission

Any patient with altered mental status of unknown etiology

Any established family medicine patient with concerns for or the diagnosis of the following:

Any adolescent patient (13-18) whose primary admitting diagnosis is recreational drug intoxication/withdrawal as long as they are not requiring intubation. This will pertain primarily to alcohol, opiates, benzodiazepines, methamphetamines, cocaine, ketamine, MDMA and other “party drugs.” Peds Hospitalist Service will consult for specific condition that would otherwise require either primary admission or Mandatory Pediatric Consult, or if Family Medicine Service requests.

Any patient with concerns for or the following diagnoses:

Admit the patient and write all orders

Daily progress note

Communicate with the PCP

Arrange PCP and sub-specialty follow up

Lead Care Conferences

Order medications, formula, and equipment for home

The pediatric hospitalist service will automatically consult for patients with concerns for or the diagnosis of meningitis, sepsis or SIRS. The family practice resident should inform pediatrics of any automatic consults by calling the admit pager.

The pediatric hospitalist service will consult for any general pediatric issues, if family practice requests a consult.

If consulted, the pediatric hospitalist service will communicate and document consultation recommendations within 12 hours.

If consulted, the pediatric hospitalist service will attend care conferences if requested.

Process of transfer:

An interim summary will be completed for any patients on the transferring service for >48 hours.

Orders will be reviewed by the transferring service and updated prior to transfer.

The transferring service will inform the family of transfer.