Admission Process

The admission process at a tertiary care center such as BIDMC is always complex. Our senior EM residents should know how to do this and can answer most questions that you or your off-service residents may have. Here is the basic admission process for your reference. The full Admission Primer is attached at the end of the page as a Word document and will be periodically updated by our ED leadership and chief residents. Please also see the video we sent you on how to use the ED Dash, it summarizes these nuances.

1. Obtain approval for admission if needed (see below).

2. Complete MD Comments

3. Click “Admission” > “Add Request” > write diagnosis > specify location/level > specify service & attending > specify “ALS” transport always > answer rest of questions > sign admit order

4. The primary provider will receive a page when bed is assigned

5. STOP (face-to-face discussion) with nurse about pt

For medicine/cardiology pts (steps 6-8):

6. E-signout: click “MD signout” > “ED MD: Click here when complete” > “ED MD: Click here to initiate e-signout”

7. The primary provider will receive a page when signout is accepted

8. Write holding orders under “Main-POE”

For MICU/FICU/CCU pts (steps 9-10):

9. Page ICU resident to give verbal signout

10. Write holding orders under “Main-POE”

For nonmedicine pts (step 11):

11. No e-signout. Wait for admitting service to write admit orders. Page reminder if no admit orders within 30 min.

Admission approval

Contact PCP for private groups (indicated under pt’s name), Geriatric patients, or the Fenway physician group. There should be a dashboard flag to remind you. See Psychiatric Patients for the protocol to treat/admit psych patients.

Service Process

Gen Med Admit to HMED

Gen Cards Admit to on-call Zoll attending

Renal tx Call Renal-Transplant fellow, admit to their attg

Liver Call GI-Hepatology fellow, admit to their attg

Oncology 8a-5p: call pt’s oncologist. Else, admit to on-call Onc attg

BMT Call BMT fellow, admit to their attg

Atrius Onc Call Atrius Onc attg, admit to them

Atrius Cards Call Atrius Cards attg, admit to them

Neuro-onc Multistep process: talk to your senior resident

ICU Multistep process: talk to your senior resident