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.
Geriatric practice patients who are stable may be admitted directly to the floor from an outside hospital's Emergency Department with approval from the Geriatrics PMD or attending physician, 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 (please also refer to section IV.5.b.)::
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
Note: 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.
Geriatrics practice patients transferred from WW ED and outside hospitals must have a sign-out provided to the Geriatrics admitting resident by the transferring physician, prior to the transfer.
B. Admission Orders
It is very important that admission orders 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.
If you are off-site, you are expected to enter the appropriate orders on CareConnect in a timely manner.
C. Admissions 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.
Admissions from Outside Hospitals The admitting resident will be notified of the direct transfer by the authorizing Geriatrics attending, as soon as the transfer is approved. Please note that only patients of providers listed in no. 1-4 under A. Who We Admit to the Geriatrics Service are eligible to be accepted for direct admission to Geriatrics.
The 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.
Admissions from RR ED Guidelines for accepting transfers from the RR ED. These apply to patients who meet the above criteria and who are:
deemed appropriate for transfer to SM Geriatrics by the RR ED Triage Hospitalist.
admitted to Medicine but are temporarily boarding in the RR ED while awaiting bed availability (see ix below).
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, including but not limited to 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 dispo 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 ED 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.
