Providing a Clear Path to the Direct Admission Process

Abstract

OBJECTIVES The aim of this study was to increase patient safety during care transitions through the development of a new process and electronic screening tool. BACKGROUND Direct hospital admissions that are not clinically triaged can put the patient at an increased safety risk. METHODS Utilizing the electronic medical record and mnemonic situation, background, assessment, and recommendation (SBAR), an admission module was created to intake direct admission requests by transfer center nurses to ensure clinical triage and accurate bed placement. RESULTS One hundred eighty-nine direct admissions met inclusion criteria. Thirteen patients were clinically screened, deemed not stable for the acute care setting, and sent to the emergency department. One direct admission safety event occurred involving a hypoglycemic patient upon arrival. Results indicate the new clinical screening program offered a safer way to directly admit patients to the inpatient setting. CONCLUSION Implementation of the electronic SBAR handoff tool meets the Joint Commission standard of care transitions compliance. The significant workflow changes increased patient safety and will be expanded in the future to all service lines.

Improving Direct Admissions to Internal Medicine Services

“…Our study expands on the limited data on process improvements for DAs, particularly for adult patients in academic medical centers, as it addressed DA for a large department that saw high volumes of DA with a diverse subset of medicine services that have their own unique workflows. Two prior studies in similar settings, one implementing a protocolized step-by-step flow diagram 9 and the other utilizing the transfer center for DA intakes, 10 were limited to smaller volumes of DAs. In addition, our intervention took a practical approach, utilizing low-cost and generalizable EMR tools that may be more easily implemented than previous studies staffing a telephone hotline 8 or setting up a referral and care coordination system 11 .…”

“…6,7 Of the available research, there have been only a handful of studies focused on quality improvement initiatives for DAs. The studies had varying process interventions including implementing a call center, 8 creating a standardized process that included communication with a designated medical admitting resident, 9 and creating a DA module to gather intake information, 10 with modest improvements in physician satisfaction and patient safety measures. More work is needed to evaluate and guide DAs, especially encompassing handoffs and communication that can be broadly implemented in complex care settings.…”