General Medicine Admitting Flow

Updated 10/6/2015
Dr. Puri and Dr. Stern are no longer going to be serving as the “GENS Geo” physicians who actively direct patient flow to our GENS teams. They however are still the Gen Med Inpatient Medical Directors and are available to provide guidance on inpatient flow and disposition issues.

Given their changing roles, there are now a number of new guidelines for admissions to GENS, OSH transfers, and/or admissions from PCG.

FOR PCG CLINIC PATIENTS

For PCG clinic patients that you want to admit directly from clinic or home:

  1. You no longer need bed geo approval from Drs. Stern and Puri.
  2. You should discuss the admission with your clinic attending or firm trio attending.
  3. The attending MD for the RFA (request for admission) is the attending with whom you have discussed the case.
  4. Call an expect to the MROC and/or GENS admitting pager and document in a phone note.

If the transfer center calls you about your own PCG patient wanting to transfer here from an
outside hospital,

  1. Return the transfer center’s page, and also talk to the OSH doctor requesting transfer.
  2. Once you have gotten the story, call your clinic attending or firm trio attending to discuss the transfer.
  3. If you and your attending agree to transfer, then place an RFA and communicate to the transfer bed desk that you’ve accepted the patient.
  4. Again, call an expect to the MROC and document rationale for transfer in a phone note.

FOR PATIENTS FROM OTHER SERVICES

You may also receive other calls while carrying the GENS pager (4367):

  • A medicine-based subspecialist wants to admit or transfer a patient to a Gen Med service – You should consult with your team’s attending and/or the patient’s UChicago PCP before accepting the patient to GENS.
    • Example: Dr. Cardiologist has a patient in clinic with a history of CHF who presents
      with pneumonia. The patient’s CHF is currently well controlled. Dr. Cardiologist wants
      to admit the patient to GENS for inpatient antibiotics.
  • In summary, the workflow for transfer requests from other services is as follows:
    1. Return the page to the requesting team and get a sign-out, but advise the team you need
      to run the transfer by your attending.
    2. If you and your attending together decide to accept the patient, let the transferring team
      know.
    3. If the transferring team is in the CCD,
      1. The transferring team puts in a transfer order for a Mitchell bed and calls the bed
        desk.
      2. Your team assumes care once the patient arrives in Mitchell.
      3. In the meantime, the transferring service will manage the patient and obtain a Gen Med Consult or other medical sub-specialty consult if necessary.
  • Surgical team wants to transfer to GENS
  • Workflow for transferring patients from General Surgery to Medicine (Updated Spring 2015 in CLOC):
    1. All requests for transfers are directed to #9000 Hospital Medicine Consult Service
    2. For accepted patients, General Surgery writes transfer orders in EPIC to General Medicine in Mitchell and these patients are placed on General Medicine Admissions/ Expects List.
    3. At the time the patient receives a bed in Mitchell, the receiving service #4367 (Housestaff vs Hospitalist) should contact the listed provider (under the “Paging Contact Info” tab in EPIC) to obtain sign-out from Surgery Service and assumes the care as a primary service
    4. Hospital Medicine Consult Service assumes care as primary service in CCD if: a. Patients are not physically transferred to Mitchell by 6 am next day or b. The acuity of medical issues requires the medical service to assume care immediately.
    5. The disagreements between the services regarding the appropriateness of the transfers or the intensity of care that requires the immediate assumption of care by medicine service are escalated to the level of Clinical Operations Director Hospital Medicine / General Surgery Residency Program Director.  

 

FOR PATIENTS NOT AFFILIATED WITH U OF C

If you are called about an OSH transfer who is not established with any PCG physician or UCM subspecialist, please refer the Transfer Desk to the Medical Director (pager 4436).

FOR OTHER DISPO AND FLOW ISSUE

Finally, if you need additional help on GENS, either Dr. Puri or Dr. Stern is always covering pager 4436 and can assist you in the following:

  • Serving as a resource for problem resolution and removal of barriers to appropriate patient
    disposition

    • Example: Your patient with osteomyelitis needs 6 weeks of antibiotics. The
      patient’s medical problems are basically stable. She has just been awaiting home
      antibiotics to be set up for the last several days.
      Providing guidance and education related to utilization issues, level of care, and patient
      logistics.
    • Example: Dr. Geriatrician pages you to admit her patient from clinic “for
      placement,” but the patient does not appear to meet any criteria for admission. Your
      intern writes an “Admit to Observation” order, and your attending has no idea what
      to do.
  • Providing advice, facilitating communication, and helping mediate disagreements between
    services and provider teams.