Pathways for ED Hospital Admissions Baptist Memorial Hospital-Golden Triangle

ANY TYPE AORTIC DISSECTION

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ANY TYPE AORTIC DISSECTION

CV SurgeonConsult IM or Cardiology, as

needed

ER physician has final authority for disposition of all patients.Patients admitted to Intensivists in ICU by pathway, can be referred back to primary physician upon discharge from ICU. If unreferred patient, upon discharge from ICU, refer to physician on call for unreferred on day of admission.

BMH-GT Pathways for Admission from ED

CHEST PAIN

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CHEST PAIN

ST segment elevation > than

2mm or ↑ of troponin

Patient without MI

Cardiology

If patient has known CAD

Patient without Hx of CAD/

other

Cardiology

IM/on call

BMH-GT Pathways For Admission From ED

ER physician has final authority for disposition of all patients.Patients admitted to Intensivists in ICU by pathway, can be referred back to primary physician upon discharge from ICU. If unreferred patient, upon discharge from ICU, refer to physician on call for unreferred on day of admission.

CHF in need of Admission

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CHF

Patient followed by Cardiologist

All other CHF

Admit Cardiology

Admit IM, with consult to

Cardiology as needed.

BMH-GT Pathways For Admission From ED

ER physician has final authority for disposition of all patients.Patients admitted to Intensivists in ICU by pathway, can be referred back to primary physician upon discharge from ICU. If unreferred patient, upon discharge from ICU, refer to physician on call for unreferred on day of admission.

GI BLEED

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GI BLEED

Patient without concurrent

serious medical illness.

Call GI

GI admit with IM consult, if

needed*

IM admits after discussion with

GIPatient with multiple life threatening

medical problems

IM admits with GI consult

GI calls IM if plan is to admit to IM (discuss plan for elective endoscopy, etc.).

BMH-GT Pathways For Admission From ED

ER physician has final authority for disposition of all patients.Patients admitted to Intensivists in ICU by pathway, can be referred back to primary physician upon discharge from ICU. If unreferred patient, upon discharge from ICU, refer to physician on call for unreferred on day of admission.

BRAIN HEMORRHAGE

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BRAIN HEMORRHAGE

Notify Neurosurgeon

to see

If unavailable

If available Neurosurgeon and Medical Consultants

(Critical Care or Hospitalist) will discuss case

and decide who will be admitting

physician.

*Neither will ask ED to deliver messages.

Transfer to another facility

BMH-GT Pathways For Admission From ED

ER physician has final authority for disposition of all patients.Patients admitted to Intensivists in ICU by pathway, can be referred back to primary physician upon discharge from ICU. If unreferred patient, upon discharge from ICU, refer to physician on call for unreferred on day of admission.

ISCHEMIC INFARCT - STROKE

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ISCHEMIC INFARCT - STROKE

TPA candidate *

Not candidate for TPA

Consult Neurology

Consult NeuroAdmit to IM with Neuro consult

Give TPA in ERAdmit to IM with Neuro consult

* Need proper education on administration of TPA. Until then, if Neuro is not available, bypass to another facility.

BMH-GT Pathways For Admission From ED

ER physician has final authority for disposition of all patients.Patients admitted to Intensivists in ICU by pathway, can be referred back to primary physician upon discharge from ICU. If unreferred patient, upon discharge from ICU, refer to physician on call for unreferred on day of admission.

NEW RENAL FAILURE

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NEW RENAL FAILURE

If patient requires acute hemodialysis *

Nephrology to admit

IM to admitIf hemodialysis not expected

during this admission

* Need guidelines for requirements for HD

BMH-GT Pathways For Admission From ED

ER physician has final authority for disposition of all patients.Patients admitted to Intensivists in ICU by pathway, can be referred back to primary physician upon discharge from ICU. If unreferred patient, upon discharge from ICU, refer to physician on call for unreferred on day of admission.

PNEUMONIA

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PNEUMONIA

If patient has pulmonologist

following

Admit to pulmonary

If mechanical ventilation required

If patient not followed by

pulmonologist

No mechanical ventilation required

IM to admit

Pulmonary to admit

BMH-GT Pathways For Admission From ED

ER physician has final authority for disposition of all patients.Patients admitted to Intensivists in ICU by pathway, can be referred back to primary physician upon discharge from ICU. If unreferred patient, upon discharge from ICU, refer to physician on call for unreferred on day of admission.

Respiratory Distress/Failure

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Respiratory Distress/Failure

PCO2 > 55Mental Status

ChangesExcessive work

to Breathe

Admit to pulmonary

If mechanical ventilation required

PCO2 < 55

No mechanical ventilation required

IM to admit

Pulmonary to admit

BMH-GT Pathways For Admission From ED

ER physician has final authority for disposition of all patients.Patients admitted to Intensivists in ICU by pathway, can be referred back to primary physician upon discharge from ICU. If unreferred patient, upon discharge from ICU, refer to physician on call for unreferred on day of admission.

ANY OB HOSPITALIZATION

WITH MEDICAL PROBLEM NEEDING

MANAGEMENT

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ANY OB HOSPITALIZATION

OB admitsConsult IMas needed

BMH-GT Pathways For Admission From ED

ER physician has final authority for disposition of all patients

POST-OP SURGERY

COMPLICATION

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POST-OP SURGERY COMPLICATION

Surgeonadmits

Consult IM, as needed

ER physician has final authority for disposition of all patients

BMH-GT Pathways For Admission From ED

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Admission from ED

All Renal Transplant

patients (including ortho fractures)

All Peritoneal and Hemodialysis

Patients

ED Physician has final authority for disposition of all patients.

Admit to Nephrology

BMH-GT Pathways For Admission From ED