ATP (Admission Triage Pager service)
Structure Currently Monday to Friday; 7am to 5pm service Takes ATP pager from night time attending at 7am Hands ATP pager to Swing attending at 4:30 pm There is at least 30 min overlap between ATP and Swing to allow finishing any unfinished work prior to shift end at 5 pm
Responsibilities Take calls for patient from Chandler ED Chandler ICU OSH transfer Clinics Other specialties and subspecialties for possible transfers Redirect nurses, clerks and ancillary staff if they page the pager to find the correct provider
Support structure At 1 pm an APP arrive to help with admissions until 1am Sometimes there is a Flex APP between 7AM to 7PM. They can help with roughly 3 admission (AM only), and more in the afternoon if they are not helping with procedures
Morning Sign out from night attending - pending admissions, pending outside transfers Check the census for Chandler and GoodSam Call capacity command and investigate bed availability and tally the list for pending outside transfers, please clear the list on sharepoint after that. Communicate with GS3 attending regarding capacity for taking ED patients/icu transfers if there are beds at GoodSam
ICU transfer In constant touch with ICU triage attending and Capacity command regarding ICU transfers Once we have a bed and have capacity to take ICU, Capacity tells us about the patient, you assign a team and call 1885 (triage APP) to tell them about the transfer
Triaging patients from the ED Family medicine established patients go to them at GoodSam (please tell the ED to call them) Oncology established patients will go to MT6 preferably if census allows Obs patients will go to MT8 preferably based on census Decision depending on protocol and lack of services regarding which patients can go to GoodSam versus Chandler (please refer to patient transfer module) Geographic locations for specific teams Readmissions should go to the same team given same providers are still on service
Triaging patients from the ED Cardiology admits CHF exacerbations and chest pain Neurology has their own service for stroke, seizure patients All surgical branches admit their own patients except ortho: fragility fractures (>65 yrs old or cirrhosis) go to GME Please refer to the assigning patients module for details
ED patients to GoodSam Decide if they can go to GoodSam, if they have beds Do H&P and admit patient under MT8 Then put a bed request transfer to Good Sam order in Communicate regarding the patient to GS3 attending Communicate/Email MT8 attending so they are aware of the patient
ED to Chandler If resident teams have spots then they can admit during the day Non call teams can take admissions until 4 and on call team can take admissions until 7 Avoid giving resident team admissions between 9 am to 11 am, to give them some time to round Sign out the direct care admissions done by you during the shift to the respective rounding teams Direct care teams including obs team can admit for themselves if you are overwhelmed and have no help
Outside transfers Please be polite and cordial as you are representing our division Patient is stable for transfer Patient still needs to be inpatient ED patients to be accepted to ED as much as possible Does patient needs to come to medicine or needs to go to some other service, at that point you can choose to be on a three way conference to help decide with them If patient needs a procedure/surgical service please make sure to communicate with them before bringing the patient in Decide the level of care and triage patient to GoodSam/Chandler Put information of patients coming to Chandler on sharepoint, please be sure to Communicate information for patients going to GoodSam with GS3 attending via email/phone
Census at surge When Chandler census (excluding GME) is 140 or more we do not take any more outside transfers from the list of outside transfers When Chandler census (excluding GME) is 144 or more we do not take any more ICU transfers unless it is for a crash bed for ICU
Consults Please redirect all calls for medicine consults and preop evaluation to the consult service from 7 am to 4pm After hours consults if urgent will need to be seen by the swing/night attending After hours non urgent consults can be handed over to the morning consulting service after discussion with the consulting physician
Other pages Patients/pharmacy may call after they get discharged, need to be taken care off or handed over to the responsible physician Please redirect crosscover pages from nurses Please redirect pages from clerical staff, consulting services, pharmacy and lab