Harbor:Pediatric admission guidelines

Admitting guideance and rules

• Patient age
  • Pediatric ward and PICU admit patients up to age 21 years and 364 days old
    • For trauma patients, location of admission for 18-21 year old patients is at the discretion of the trauma attending
    • If another service besides trauma is asking to admit an adult patient aged 18-21 years, state that the patient should be admitted to pediatrics with the other service consulting
    • Pregnant patients < 18 years old with a pre-viable infant should be admitted (eg for hyperemesis) to pediatrics with an OB consult
    • Pregnant patients 18 years old and older to be admitted with an OB condition and all pregnant patients with a viable infant should be admitted to OB
      • Pregnant patients requiring ICU level care should be discussed with the critical care attending
  • Patients < 1 month old with no respiratory symptoms or diarrhea may potentially be admitted to NICU or nursery
    • Discuss with admitting nursery (x2311) or NICU (x2340) resident
• ED attendings have admitting privileges
  • Admissions will be accepted by pediatric residents regardless
    • Pediatric residents, in conjunction with their attending, may evaluate the patient and perform an immediate discharge if they so desire
• ED attendings determine, with admitting resident input, the appropriate location: ward, step-down, PICU
• ED should have done all of the following prior to contacting the admitting resident
  • Complete necessary work-up and treatment for stabilization that should occur acutely in the ED
  • Make sure with Utilization Review that the patient can be admitted to Harbor
    • If the attending says patient is not stable for transfer, then the patient will be admitted
    • The Interqual icon does NOT have to be green prior to contacting admitting resident IF ED staff are sure the patient will be admitted to Harbor
• Peds does not have isolation areas, so if patient needs isolation (eg active TB, meningococcemia, measles, varicella), discuss with admitting resident
  • Patient may need to be admitted to an adult area and followed by peds, or transferred

Contacting the admitting resident

• Harbor MedHub call schedule (linked from PEMsource.org Harbor only page)
• Protected time for ward admissions
  • Weekdays 6:45am-7:30am
  • Weekends 7:45am-8:30am
    • From 7am to 7:45am call the admitting resident from the night before
  • All evenings 7pm-7:30pm
• For ward and step-down
  • Mon-Fri 7a-7p: Pediatrics Ward Senior Admit resident (will be Gold or Blue, depending on which team is admitting)
  • Mon-Fri 7p-7a: Pediatrics PM Ward Senior
    • Note: mn-7a: look at the previous day's shifts (not the column in yellow on MedHub)
  • Sat-Sun 24 hours: Pediatrics Ward Senior Admit resident (see note above)
  • If unsure, can call Peds ward at x2333 to ask for admitting resident
• For PICU
  • Mon-Fri 7a-7p: Pediatrics PICU
  • Mon-Fri 7p-7a: Pediatrics PM PICU (see note below)
  • Sat-Sun 24 hours: Pediatrics PM PICU
    • Note: mn-7a: look at the previous day's shifts (not the column in yellow on MedHub)
  • If unsure, can call PICU at x2480 to ask for admitting resident
• If you forget to ask, the Attending name for Ward Blue or Gold team, or PICU will be listed on MedHub

After admission

• Once the ED staff puts in a "Request for Admit" order, the pediatrics team is managing the patient
  • ED staff should have all ED orders in and completed prior to putting in Request for Admit
    • Make sure nursing has had a chance to complete ED orders prior to putting in Request for Admit
• As part of their admission orders, pediatric residents may order additional labs, imaging, etc.
  • These do NOT need to be done in the ED prior to the patient going upstairs
  • Ultrasounds can be difficult to obtain from inpatient, so attempt to get any ultrasounds done prior to leaving ED
• For any delays in patient going upstairs, have nursing contact Patient Flow

Authors

Kelly Young, Ross Donaldson