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We transition care to the admitting attending, and the ED resident provides resident coverage if things are not overwhelming (which they usually are).  If the ED attending decides that the ED resident can not care for the boarding patient, we contact the pediatric chief resident and they find coverage (using a sick call/back-up resident system which they already have in place for the floors).  As stated below we would of course be available if the patient became unstable.

Adam


Adam Silverman, MD FAAP
Assistant Professor
Pediatric Emergency Medicine and Pediatric Critical Care
Emergency Department Residency and Medical Student Site Coordinator
Morbidity and Mortality Coordinator

Connecticut Children's Medical Center
282 Washington Street
Hartford, CT   06106

office 860-545-9739


>>> Sandra M Herr <[log in to unmask]> 1/15/2009 3:16 PM >>>
We transition floor (not critical care) holds to the inpatient service; once the official admission order/MD report has been given, they are an inpatient.  Questions, notifications, etc. all go to the admitting resident team; obviously if the patient becomes unstable or needs emergent intervention, the ED physician responds.  Once we reach more than 2 holds, a float RN is assigned to the ED (1 for every 4 holds ideally) to assume their care and provide all of the care, charting, etc. that would occur if they were on an inpatient unit.

Sandra Herr, MD
Medical Director, Pediatric Emergency Department
Kosair Children's Hospital
Louisville, KY
(502)629-5917


>>> "Rahman, Wassam" <[log in to unmask]> 1/15/2009 12:42 PM >>>
Most of us are experiencing the problem of patients being boarded in the
ED pending admission.  
 
Questions:
 
Does anyone transfer care of the patients to the inpatient service for
ongoing management?  
 
What are some of your solutions, if any?
 
Are there any "legal" billing or coding tricks to optimize reimbursement
for managing these patients till admission?  Or if of when they end up
being discharged from the ED?
 
Any input or ideas on how you handle these patients would be
appreciated. 
 
 
Wassam Rahman, M.D.
Medical Director
Emergency Center
All Children's Hospital
801 Sixth Street South
PO Box 31020
St. Petersburg, FL   33731-8920
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Emergency Center
 
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