Twenty Questions and Answers Regarding Patient Care at Erlanger Page 1 of 5 (Revised 6/2007)

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1 Page 1 of 5 (Revised 6/2007) Question 1. What are the steps for a resident to admit an inpatient? 2. Are there any special steps for admitting an urgent patient (from the ED) Answer Write admission orders The patient will move from the ED to EXAU (Express Admissions Unit located within the ED) for 2 hours where admission orders will be initiated. Utilize transitional order sets if patient going to EXAU. Keep in mind DVT prophylaxis and any core measure order sets such as AMI, CHF, or Pneumonia that may be applicable. These are found on the Intranet. Notify attending as appropriate. Complete H&P Begin the medication reconciliation process by filling out and signing the home medication order set. This is printed from the Intranet once the nursing assessment is completed. Address vaccines as appropriate As above. May alert ED charge nurse/anm about admission before orders are written to check for bed availability. 3. What are the steps for admitting a patient from another institution (transfer)? 4. What are the steps for transferring a patient to another institution? Gather transfer forms from referring facility. Contact sending MD or facility and discuss medical necessity/acceptance of patient. All calls for transfers from other institutions go through etracs who decide appropriateness of transfer. Once approved, write orders for admission as above when patient is transferred Determine ICU/med-surg disposition and notify attending as appropriate Write an order for transfer For transfer to another acute facility like Memorial, receiving MD for acceptance of patient. Involve the appropriate Case Manager on the unit or floor where pt. is admitted to facilitate the Pt. transfer Complete Transfer Authorization form #CN3010, Transfer Order #DO2301, and Discharge Medication Order Set (printed from

2 Page 2 of 5 (Revised 6/2007) 5. What are the steps for transferring a patient into a critical care unit? 6. What are the steps for transferring a patient from a critical care unit to a regular patient room? Intranet with current medications) For transfer to Siskin, Nursing Home, complete forms as above signing Medical Necessity Form if using ambulance (issued by ambulance forms available on the units/floor). Document reason for transfer in progress notes. Case management should be involved early and should be contacted directly on difficult/complex issues involved in Pt. transfer. V.A. transfers require MD to MD contact for approval of transfer Notify attending and family as appropriate Write transfer order on order sheet Complete Transfer Medication Orders (printed from Intranet) and Critical Care orders as appropriate. Document findings and need for transfer in progress notes Nurse contacts etracs at 7355 for ICU bed As above 7. How does a resident order diagnostic tests for an inpatient? 8. How does a resident request a consult from another specialty or service? 9. How does a resident schedule a patient for inpatient surgery? Write an order for test. Nurse or unit clerk enters order in computer, sends a requisition or schedules Writes an order The nurse or unit clerk contacts service. Can contact service by self - Need to document on order sheet or progress note that the consult was done by MD (resident). This alerts unit clerk/nursing/c.m. that the consult was called. Write an order for surgery. Or consult surgeon who then will schedule surgery and other appropriate consults (anesthesia, etc) Document findings in progress note and keep attending in loop Discuss with patient/family and obtain

3 Page 3 of 5 (Revised 6/2007) 10. How does a resident schedule a patient for outpatient surgery? informed consent Contact Outpatient Surgery at Are there pre-operative testing requirements? Refer to pre-op checklist for EKG by age, labs, radiology 12. What is the general procedure when a patient dies, and what is the resident s responsibility if they are involved in the patient s care or in pronouncing a patient? 13. Describe the resident s role in completing birth certificates Pronounce patient. Notify family. Staff notifies TDS for organ donation Write order to transfer to morgue Document findings in progress notes Fill out Tennessee Department of Health Certificate of Death form # PH-1659) See attached. MD s do not sign birth certificates per L&D 14. Describe the resident s role in completing death certificates. Fill out form. However, only a resident with a full, unrestricted resident license can legally sign a death certificate in Tennessee. 15. When is an autopsy required? The same holds true as when an autopsy is advised. The Medical Staff s Rules & Regulations state: 39. Members of the Medical Staff should suggest and attempt to secure an autopsy for the following: 1. No probable diagnosis to explain the death. 2. Death incident to pregnancy. No autopsy shall be performed without written consent of a relative, unless the autopsy is required by law. 16. When is an autopsy advised? No probable diagnosis to explain the death Death incident to pregnancy. No autopsy performed without written consent of a relative unless the autopsy is required by law. 17. What does a resident do if a patient refuses treatment? Document what patient says in progress notes, advise patient/family of adverse

4 Page 4 of 5 (Revised 6/2007) 18. What is the procedure for discharging a patient? 19. Does Erlanger have approved order sets that are recommended for certain conditions: effects of decision making and document. Contact case manager for disposition if appropriate Keep attending in loop Write an order to discharge (attending may see patient prior to discharge) Gather and complete discharge order sets (Form DO2301 found on Intranet) Consider core measure requirements/addendum order sheets Complete Discharge Medication Order printed from Intranet and reconcile home medications prior to discharge. Determine prescriptions/future appointments needed, home care, etc. Involve case management EARLY for Pt. needs such as IV ABX/DME/VAC PACKS/HOSPICE, etc. that will require planning. This becomes more critical when INDIGENT Patients have such needs as the process for arranging such things becomes more complicated. The following specific order sets have been approved by the Erlanger Medical Staff Leadership and can be found on the Erlanger Intranet web page under Patient Care on the left hand menu- then Order Sets: 4540 DVT Prophylaxis 4602 Surg Antibiotic 4100 Pneumonia 5045 Heart Failure 5043 Acute Coronary 5044 Stemi There are numerous order sets that can be downloaded from this site, including: Adult Critical Care Anesthesia Burn Circumcision Orders Discharge Orders EmCare Hospitalists Emergency Transitional Orders Erlanger North Sleep Lab

5 Page 5 of 5 (Revised 6/2007) 20. Are there any other patient care procedures that residents should have/read and should be included in the online resident handbook? Gastroenterology Heart and Vascular Services Infection Control NeuroSurgery Neurology Nursing Oncology Ophthalmology Organ Donor Pediatrics Pharmacy (Adults and Peds) Pulmonary Radiology Renal Surgery Cardiac Surgery General Surgery Oncology Surgery Oral Surgery Orthopaedic Surgery Vascular Trauma Surgical Critical Care Urology Women s Services Wound Care Order Set Template From a JCAHO/credentialing point of view, dating and timing of orders, legibility, use of pager number, ordering and dating and timing type of restraints (Form #RS0616), AMA form, use of unapproved abbreviations, signing verbal orders within 48 hours, H &P s, and medication reconciliation