Pre-Admission Order Policies

Writing orders as a patient is on his way to the hospital is a key success factor in patient safety issues. One potential problem with these types of pre-admission solutions involves the potential to misidentify the patient.

Issues

The following policies represent one organizations attempt to deal with these issues:

Direct admits

A call to admissions gets a temporary account in the clinical system on which the doctor can enter orders. The name looks good to the provider, but it is in fact a holding account that goes nowhere till the identity is perfected. We don't allow office personnel to enter the orders, only hospital credentialed MDs and mid-levels. We guarantee 30 minute fulfillment on creating these holding accounts (but more typically <10 minutes except for peak admission volume time from 4-6pm) where the provider can enter his orders. This account identity is in the system generically but not perfected, and not released or activated till the patient or their family member has been to admissions where a professional reg person perfects the identity.

Example: an internist with a pneumonia case, or office directed urgent but non-ED case.

Scheduled surgery

Our OR scheduling system is separate from the admission registration system (bad idea if you can avoid it!). So the office typically schedules the elective surgery in the OR scheduling system, and every 24 hours this list is dumped to the admissions system and the same temporary accounts created. The providers can then enter orders which follow the same workflow as the direct admits. We guarantee the providers 24 hr turnaround to enter orders on these patients, but in fact, they are all completed during the overnight slow period, so the surgeons know they can enter orders the next morning

Urgent procedure based care

This is typically our cardiology service which receives medical evacuation critical cases from around the region. Think about a case in which a local doctor in Lizard Lick, GA who has a patient with an acute MI patient. He can call an 800 number here, and get a nurse registrar who answers the phone directly and can do the whole thing from triage to registration in less than 15 minutes, including create the account for order entry, ( and delivering a wonderful level of customer service!!). This is very nice, but very expensive operationally, to provide this level of service on a 7x24 basis. Only heart doctors could afford it!

Urgent care

Think appendectomies from the office. These are handled as direct admits in number 1 (above), but the doctor is responsible for securing the urgent time on the OR calendar.