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.
1. Obtain approval for admission if needed (see below).
2. Ensure Handoff Tab has adequate information
3. Under the Epic “Dispo” tab you will click "Admit" and ensure there is a Clinical Impression
4. In the right hand column there will be a "Bed Request" section that generates you click "Order"
5. Select the Service, Level of Care, Telemetry (Y/N). Enter an attending's name if given by a consultant you've spoken to. General medicine does not need that. Sign the order.
6. This will generate a Secure Chat conversation where the inpatient team can review the case and ask additional questions.
7. Once they have accepted the patient, two green check marks will appear in the "IP MD Handoff" column.
8. Once accepted, the inpatient attending's name will appear and they will come off your list. If the check marks are present but your name is still present, you can Secure Chat the inpatient team to remind them to take over. NOTE: This is only for floor level patients. ICU level of care stays on the ED lists.
For MICU/FICU/CCU pts (steps 9-10):
9. You will receive a Secure Chat when an ICU bed is assigned, please reach out to coordinate verbal signout.
10. Once accepted ensure the green checks are put in by the ICU team, then the patient can get transported.
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 Hospital Medicine
Gen Cards Admit to Cardiology
Renal tx Call Renal-Transplant fellow
Liver Call GI-Hepatology fellow
Oncology 8a-5p: call the patient's oncologist. Else, just admit to Oncology
BMT Call BMT fellow 24/7
Atrius Cards Call Atrius Cards attending
Neuro-onc Multistep process: talk to your senior resident
ICU Multistep process: talk to your senior resident