ED TO ICU MEDICAL ADMISSION PROCESS
Metric goals for the ED
1 hour to recognize patient meets ICU level of care (put in most appropriate ICU team consult within one hour of arrival in the ED).
1 hour to either place bridging orders (with ICU team agreement) OR the ICU team writes their primary orders
So, two hours till patient admitted to an ICU service is the goal set for the ED.
We all know that some patients crump in the ED and become ICU level care after they’ve been there awhile. Just put the ICU service consult in as soon as you know. Also please cancel the non-ICU level consult for admission. This decreases confusion for our admitting colleagues.
And vice versa; if patient is adequately resuscitated in the ED and no longer requires ICU level care, please discontinue ICU consult and place consult for another appropriate admitting team.
Notice this is for medical admissions. This process does not apply to the SICU (services admit to SICU and the patient stays under their service while in the SICU).
ADMISSION PROCESS
1. Place most appropriate ICU service consult order within 1 hour
2. Speak with the ICU team you believe is most appropriate for the patient
3. Determine if a bed is available
4. If yes—a bed is available, have a discussion with admitting person on call and if the admission seems clear-cut AND they agree, place BRIDGING ORDERS (ED Service Designation Orders)—you’ll need the name of the service attending
5. If no bed available in that ICU, please contact patient placement @ ext 87511. Patient placement will determine location of another ICU bed (repeat steps 1-4).
**remember ECICU as a place for other medical ICU admits. You can check with them first if patient is appropriate for ECICU before contacting MICU or Patient Placement **
**do not be thrown off if you are told there are only unstaffed beds (no nursing). The ICU service can still take the patient with unstaffed beds and will work on getting staffing**
PROCESS FOR WHEN ANY ICU TEAM DOESN’T INITIALLY AGREE WITH ADMISSION OR THE PLACEMENT OF BRIDGING ORDERS
ICU team will further evaluate and provide decision to ED within 60 minutes
If the decision is not to admit the patient to ICU then
i. the ICU team will verbally inform the ED team and
ii. the ICU team will write a brief consult note stating the reason
If no decision is provided to ED within 60 minutes after the initial consult then
ED will place bridging orders and patient is considered admitted to the ICU
Patient can be transferred to ICU
ICU completes formal admission orders
If there is disagreement about additional diagnostic testing prior to admission (e.g. CTs etc), this should be directly discussed attending to attending.
IMPORTANT POINTS
If the patient is admitted to the ICU, the ED must continue to provide optimal patient care in partnership with the ICU team prior to complete ICU service orders. Please CONTINUE to resuscitate, diagnose and treat the patient after bridging orders. Work collaboratively with the ICU team to manage the patient.
ED attendings/residents are still expected to respond to any admitted patients that have an acute change in status until primary team can take over (responding to a “rapid response” or “code blue” on admitted patients in the ED).