APP Admitter Standard Operating Procedure¶
Section of Hospital Medicine Vanderbilt University Hospital December 30, 2024
Admitting Process:¶
Touch base with the Medicine Admission Coordinator (MAC) via text or phone (615-540-4213) at 7 AM to determine: Number of holdovers Number of Morgan teaching spots available Reach out to the Staging Team Attendings to assist with triage, as needed MAC to page APP Admitter pager with details for each new admission Review patient for appropriate team designation, level of care, and admission status (obs vs. Inpt) Admit if patient appropriate for hospital medicine Re-triage to Morgan if appropriate (this can be based on patient complexity/acuity, multiple admissions at once, several available spots, etc.). Text the MAC that the patient should be re-triaged to Morgan. Check with MAC throughout the day regarding available Morgan spots. Morgan spots open throughout the day.
If the patient qualifies for a DOM specialty service (Rogers, Cardiology, Heme/Onc), please reach out to the MAC to reassign if space is available.
Re-triage to Obs if Obs appropriate – discuss directly with the Obs Attending and alert the MAC to the change.
If the patient is deemed inappropriate for level of care (needs ICU level of care), please reach out to the Staging Team Attendings for assistance in escalating.
If the patient is deemed inappropriate for hospital medicine based on the SDL, please reach out to the Staging Team Attendings for assistance in escalating.
See patients within 2 hours of assignment
Complete an H&P on the same day as patient evaluation
Staging Team Attendings provide oversight but are not required to see APP admits on the same day of admission or attest same-day H&Ps
APPs should perform up to 7-8 admissions in a 12-hour shift. The last admission should be assigned before 5:30 PM with the expectation that an admission will be done after 4pm. Direct Admits: The Admitter will get called about specialty direct admissions when Rogers/Onc services are capped, as well as general medicine direct admissions. Many do not arrive before 4 PM. These can be placed on the PaCT Staging or Traditional Staging team, whichever is more appropriate.
For direct admits do the following:¶
Call back the contact number and get the story Jot down a very brief clinical update in the chart with why the patient is coming and what they need on arrival Keep track of teaching team spots: If the patient is more appropriate for a teaching team (including Morgan), you may change the assignment once the patient arrives to the unit. To do this, contact the MAC who will update the assignment. Alert Night 1 of any pending direct admits at 4 PM
Admit Surge Plan:¶
Admission boluses are stressful but can be managed. Note that a bolus of patients at the beginning of the day is much different (better) than later in the day. Remember that you have 2 hours to see patients, the average number of daily admissions is ~4, and that Morgan and other teaching spots become available as the day progresses. Start with reviewing the patients for safety. If one of the patients is active (afib w/ rvr, active chest pain, sepsis, etc.), please review with the Staging Team Attending to assist. Generally, 3 stable patients can be seen within 2 hours, but this will vary per provider. Bolus plan: At 7 AM: APP Admitter to work with MAC and PaCT Staging 1 Attending on distribution as follows: Check number of teaching spots and assign as needed 6 admissions can be divided between the APP admitter and Obs physician 7th holdover admit should be admitted to the PaCT or Traditional staging teams by the Procedure Attending Additional holdovers discuss with the AOD At ~11 AM: APP Admitter to work with MAC and PaCT Staging 1 Attending on distribution as follows: Check number of teaching spots and assign as needed If APP admitter has received 4 total admissions and no teaching spots available, the APP admitter should work with the MAC and PaCT Staging 1 Attending on bolus distribution as follows: Next 2 admissions to PaCT Staging Attendings Next admission to Obs physician if they have received <4 total admissions Additional bolus patients discuss with the AOD At ~3 PM: APP Admitter to work with MAC and PaCT Staging 1 Attending on distribution as follows: Check number of teaching spots and assign as able If APP admitter has received 6 total admissions and no teaching spots available, the APP admitter should work with the MAC and PaCT Staging 1 Attending on bolus distribution as follows: Next admission to PaCT Staging Attendings if they have not yet received an admission Next admission to Obs physician if they have received <6 total admissions Additional bolus patients discuss with the AOD
| Team | Division | Provider | Cap | Admitting | Details |
|---|---|---|---|---|---|
| Morgan 1-6 | DGIM | Teaching | 10 | 6:30 - 5:30 pm | MORGAN Teams admit each day. USE ALL DAYTIME MORGAN SPOTS |
| Rogers Hep | GI | Teaching | 10 | 24/7 | Prefer transplant patients/candidates only |
| Rogers Pulm | Pulm/CC | Teaching | 10 | 24/7 | Any pulm-oriented patients, prefer ILD |
| ALDS | Pulm/CC | APP | None | 24/7 | All lung transplant and pulmonary hypertension (on prostaglandin infusions), even those not followed at VUMC |
| Rogers ID | ID | Teaching | 10 | 24/7 | Any ID-oriented patients/prefers HIV |
| Rogers Renal | Renal | Teaching | 10 | 24/7 | Prefer transplant patients only |
| Onc A | Heme/Onc | Teaching | 10 | 24/7 | Solid onc patients followed by VUMC |
| Onc B | Heme/Onc | Teaching | 10 | 24/7 | Solid onc patients followed by VUMC |
| Onc C | Heme/Onc | APP | 7 | 24/7 | Solid onc patients followed by VUMC |
| Brittingham A | Heme/Onc | Teaching | 8 | 24/7 | Leukemia/Lymphoma patients followed by VUMC or AML pts |
| Brittingham B | Heme/Onc | Teaching | 8 | 24/7 | Leukemia/Lymphoma patients followed by VUMC or AML pts |
| Browning | Heme/Onc | APP | 15 | 24/7 | Leukemia/Lymphoma patients followed by VUMC or AML pts |
| BMT | Heme/Onc | APP | None | 24/7 | BMT patients (sometimes patients w/ remote history will come to Riven) |
| Sickle Cell | Heme/Onc | APP | None | 24/7 | Sickle Cell patients w/ VOC without fever, complications, or concern for acute chest |
| Page-Campbell D/E | Cardiology | APP | 16 total | 24/7 | Assigned by Cardiology Triage - medically complex cardiac patients, or cardiac-adjacent conditions like PE, HTN urgency, volume overload |
| Page-Campbell F | Cardiology | Attg-only | 12 | 24/7 | Can be assigned Riven overflow at 4pm/6am if not capped |