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Ask the expert: What are some guidelines in developing patient admission protocol?

Hospitalist Leadership Connection, October 5, 2010

Some hospitalist programs require primary care physicians or referring providers (e.g., outpatient physicians and specialists) to sign an agreement before allowing a hospitalist to care for their patients.

• Regardless of whether your program requires this sign-off, at minimum, admission protocol should include the following considerations:
• Hospital of admission: The hospitalist practice must clearly indicate to which hospital(s) they admit.
• Emergent admissions: The hours of service that hospitalists are available for emergencies should be indicated. These services are typically rendered 24 hours a day.
• Elective admissions: The hours of service for elective admissions should be indicated. In some programs, elective admissions occur during regular work hours (7 a.m.–5 p.m.), when hospitalist and hospital staffing is greatest.
• Patient evaluation: Most programs define the appropriate process for admission assessment. For example, the hospitalist practice may consider admitting a patient only after evaluation by the primary care physician/referring or emergency department provider. Some practices will admit the patient in the emergency department if evaluated (same day) in the office by the primary care physician/referring provider, thus avoiding an additional evaluation and charge by the ED provider. Most practices discourage or disallow direct floor admissions, particularly if the patient is not seen by a physician prior to admission (i.e., the same day).

The above except is adapted from Hospitalist Case Studies: Tactics and Strategies for 10 Common Hurdles, published by HCPro, Inc.

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