A. General Requirements
- Monitored patients must be seen and admitted by the resident within 2 hours. The admitting resident should assign himself/herself to the patient's Treatment Team on Care Connect, upon admission. Click here for Who We Admit to Geriatrics.
- Geriatric Practice patients who are stable may be admitted directly to the floor from an outside hospital with approval from the Geriatrics Attending and with signout to the admitting resident from the transferring clinician, and must be seen by the admitting resident within 2 hours of arrival on the floor.
- Stable non-monitored patients must be seen within 6 hours. These include non-monitored admissions from SMH ED.
- All Geriatric practice patients being seen in RR-ED who require hospitalization should be transferred to SMH, with the following exceptions:
- clinically unstable patients
- imminent need for surgery and need for consult services that are only available at RRUCLA (e.g. intracranial surgery, urgent ophthalmologic evaluation, need for cardiac anesthesia, transplant services)
- active psychiatric issues that require a hold and direct Neuropsychiatric Hospital admission patient/surrogate who decline transfer
- Geriatrics Practice patients transferred from RRUCLA ED and outside hospitals must have a sign-out provided to the Geriatrics admitting resident by the transferring physician, prior to the transfer.
- Geriatric Practice patients who are currently already hospitalized at RRUCLA are not to be transferred to SMUCLA for placement or discharge purposes only. They are only to be transferred if they require ongoing hospital care. Please discuss with the attending Geriatrician prior to accepting the patient.
- Click here for important details pertaining to the Outside Hospital and RRUCLA Lateral Transfer Policy.
B. Admission Orders
- Admission orders are be done promptly to facilitate throughput from the ED to the floor. Whenever applicable, the admitting long call resident may write an initial abbreviated Admit Order indicating the level care (i.e. non-intermediate, non-ICU) to promptly secure a bed assignment in 5NW (Geriatrics Unit). If the abbreviated Admit order is entered before 9 PM, this will prompt the staff to free up a Geriatrics Unit bed for the new geriatrics admission.
- Admissions Orders must be entered in Care Connect after sign-out is received from the ED attending physician.
- On admission, strongly consider ordering PT eval (unless strictly contraindicated) so the patient can be seen and evaluated for discharge to Home vs SNF and to facilitate efficient discharge planning, as it normally takes 24 hours from the time the order is placed for the patient to be seen. PT eval order may be placed before final read of imaging (i.e. r/o fracture) but indicate pending imaging study in order to alert the Physical Therapist.
- For hemodialysis patients: Place renal consults earlier in the day so patient can receive HD sooner; consult can be placed as an order w/ a return pager via CC.
C. Admissions of Geriatrics Practice Patients from Clinical Sites Other Than SM-UCLA ED
- Admissions from Geriatrics Outpatient Offices
- Geriatrics PMDs will provide the admitting resident with a sign-out on the patient. If the PMD has not called to sign out the patient being admitted during office hours, please feel free to page or email him or her and obtain additional information.
- Admissions from the Skilled Nursing Facilities (SNF)
- During office hours:
The SNF Geriatrician or fellow will provide the admitting resident with a sign-out of the patient. If the SNF Geriatrician or fellow has not called to sign out the patient being admitted during office hours, please feel free to page or email him or her to obtain additional information.
- After hours and weekends:
Please contact the SNF charge nurse to obtain additional information, including a copy of the patient's current medications as they have likely changed from the patient's last encounter at a UCLA clinical site. Request that a copy of the current medication list at the SNF to be faxed, attention to you. The fax number for 5NW Front Desk is (424) 259-6667. The contact information of the various UCLA Geriatrics-affiliated SNFs is posted in the IDR Room.
- During office hours:
- Admissions of Geriatrics Practice Patients from RR-UCLA
Guidelines for accepting transfers from the RR-UCLA (ED and floor-to-floor transfers):
- Patients must be clinically stable and are anticipated to need at least an additional 48-hour stay. If it is less than that and the patient is already admitted to Medicine as an RR ED boarder, the patient is to stay with the RR Medicine team for continuity of care.
- Patients do not require consult services that are only available at RRUCLA, including but not limited to transplant services, urgent ophthalmology evaluations and cardiac anesthesia services.
- A reassessment must be performed by the RR ED Triage Hospitalist or the RR Medicine team (if an ED boarder) prior to the departure to SM to ensure that the transfer decision is still appropriate at the time of the actual transfer.
- Patient care continues to be progressed up until the time of the actual departure for SM Geriatrics, including pre-operative assessment and note for patients who require urgent surgeries such as hip fracture surgeries.
- If admitted to Medicine as an ED boarder, the RR Medicine attending physician has staffed the patient and has approved the final decision to transfer to SM Geriatrics.
- The transfers are not for discharge purposes.
- If appropriate, the Geriatrics team will provide feedback regarding these transfers to ensure that patient transfers continue to align with the mission to provide safe and patient-centered care that avoids treatment delays and discharge delays related to the transfer process.
- All RR transfers must have a signout from the transferring physician before arrival on the floor.
- If a patient who was originally planned for transfer to SM Geriatrics is instead transferred to a regular med/surg bed at RR, the original transfer request to SM Geriatrics is automatically cancelled. In the unlikely event that a transfer is still warranted, a new transfer request and a reassessment by the RR primary team will be necessary.
- Patients with active psychiatric issues that require a hold and direct Neuropsychiatric Hospital admission.
- Admission of Geriatric Practice Patients from Outside Hospitals
- The admitting resident will be notified of the direct transfer by the Transfer RN or or authorizing Geriatrics attending, as soon as the transfer is approved.
- The Transfer RN or authorizing Geriatrics attending will provide the admitting resident with the name and the contact information of the physician in the originating hospital to facilitate direct communication and a detailed handoff of clinical information.