Service (Team) Designation List¶
The following table:
| Primary Concern | Reason for Admission | Designated Team (in order of preference) |
|---|---|---|
| Cardiac | Potentially cardiac related problems (chest pain) in nephrology patients | Cardiology |
| Cardiac, Pulmonary | Patients with both heart failure and COPD with unclear primary etiology causing their acute problem | ED determined (ED attending to decide) |
| CNS | Acute Stroke, TIA | Stroke Service (Neurology) |
| CNS | Acute, nontraumatic, intracerebral hemorrhage | Stroke Service (Neurology) |
| CNS | Acute, repetitive seizures | Gen Neurology |
| CNS | Seizures of unknown cause | Gen Neurology |
| CNS | Status epilepticus | Gen Neurology (ICU) |
| CNS | ALS with decompensation or dyspnea not due to an acute infectious/metabolic problem | Gen Neurology |
| CNS | Concern with DBS (deep brain stimulation) | Gen Neurology |
| CNS | DBS system disruption or infection | Neurosurgery |
| CNS | DVT/PE in patient with known brain tumor | Gen Neurology |
| CNS | EEG-proven nonconvulsive status epilepticus | Gen Neurology |
| CNS | Hydrocephalus with VPS obstruction | Neurosurgery |
| CNS | Intracerebral Hematoma (Hypertensive stroke) | Neurology (per established protocol) |
| CNS | Limited (non-operative) non-traumatic subdural | Neurosurgery if SDH is extensive enough to require Q1h/Q2h neurochecks, otherwise Gen Medicine if SDH is small and pt has other active medical problems |
| CNS | Multiple Sclerosis acute exacerbation | Gen Neurology |
| CNS | Myasthenia gravis crisis | Gen Neurology |
| CNS | New brain tumor/mass | Neurosurgery if isolated or patient needs urgent CNS operation, otherwise Gen Med or Onc if patient has other masses that are likely primary source |
| CNS | Sudden worsening in patient status with previously diagnosed brain tumor (including mets) related to edema, seizures, mental status change | Gen Neurology attending to decide neurosurgery versus neurology |
| CNS | Critically ill patients with primary neurologic condition that need further stabilization or diagnostic procedures (such as MRI) | May admit to NeuroICU team with further team assignment as patient condition warrents |
| Primary Concern | Reason for Admission | Designated Team (in order of preference) |
|---|---|---|
| CNS | Periodic paralysis with acute weakness | Gen Neurology |
| CNS | Pituitary adenoma | Gen Medicine with Endocrine Consult |
| CNS | Pituitary apoplexy (with visual changes) | Neurosurgery |
| CNS | Possible acute Guillain Barre | Gen Neurology |
| CNS | Non-Traumatic subarachnoid hemorrhage (even if CTA normal) | Neurosurgery |
| CNS | Traumatic Brain Injury from limited trauma | Trauma (per established protocol) |
| CNS | VP Shunt with Fever | To neurosurgery with positive tap, else medicine |
| CNS | Massive stroke or CNS bleed deemed non-survivable. | Palliative care may choose to accept, otherwise to neurology or neurosurgery per primary SDL diagnosis. |
| Derm | Concern for SJS/TEN | Eval in ED by Derm then Burn Unit if SJS/TEN suspected. For other dermatologic care requiring hospitalization admit to GMD. |
| ENT | ENT abscess, nonodontogenic (whether drained in ED or not) | ENT |
| General | Non-VMG patients with a problem generally handled by a specialty service | ED determined - The same specialty service that would handle a similar VMG patient |
| GI Bleed | GI bleeds requiring an ICU | MICU |
| GI Bleed | Hemodynamically stable GI bleeds | Medicine |
| GI | Acute/chronic pancreatitis (without gallstones) | Medicine |
| GI | Gallstone pancreatitis | Rogers GI (EGS if capped) |
| GI | Cholecystitis | EGS |
| GI | Choledocolithiasis | Rogers GI (GMD if capped) |
| GI | Pancreatic pseudocyst with obstruction, bleeding, peritonitis | EGS (medicine if no obstruction/bleeding/peritonitis) |
| GI | Abdominal or pelvic abscesses requiring IR drainage | Primary surgical service or EGS if no prior VUMC service |
| GI | Complications of cirrhosis (non-bleeding, not followed by GI) | Riven Hospitalist |
| Hand | Non-surgical hand infections in a medically non-complex patient | Hand service on-call |
| Head & Neck Hemorrhage | Hemorrhage (severe) above the clavical (head and neck) | Involve In-house Trauma Attending (615-480-1149), Neuro IR, ENT, Vascular Surgery |
| Hemorrhage (severe) | Hemorrhage (severe) below the clavical (not head and neck) | In-house Trauma Attending (615-480-1149), Vascular Surgery, Interventional Radiology |
| Primary Concern | Reason for Admission | Designated Team (in order of preference) |
|---|---|---|
| ID | Catheter associated infections | ED determined - Service that is managing the catheter with ID consult as needed |
| ID | Osteomyelitis | Gen Medicine or ID at discretion of Medicine Triage Attending. Ortho if imminent surgery required (a level 1 or 2 case). |
| ID | Patients with HIV and an illness that would generally be handled by a subspecialty service | ID if followed by CCC, otherwise subspecialty service with RogersID consult |
| Medicine/Cardiac | Indeterminate or slightly elevated troponin levels in patients with another issue (hip fracture, pneumonia etc...) | Gen Medicine with cardiology consult |
| OB | <20 week pregnancy with a medical problem | Gen Med or Subspecialty Medicine with OB consult |
| OB | <20 week pregnancy with a surgical problem | Surgery with OB consult |
| Oncology | Newly diagnosed neoplasms without established tissue diagnosis | Gen Medicine (except new leukemia with >20% blasts goes directly to Brittingham) |
| Oncology | Oncology patients followed by Non-VMG oncologists | Gen Medicine, (ED Hematology/Oncology consult) |
| Oncology | Oncology patients followed by VMG oncologists where the primary cause of admission is active cancer, complication of cancer therapy, or late effects of cancer | Oncology |
| Oncology | Oncology patients followed by VMG oncologists who are being admitted for non-cancer related diagnoses | Team as determined by the SDL related to the primary admitting diagnosis |
| Ophthalmology | Isolated ocular infections | Rogers ID team with Ophtho consult (Riven/Morgan if Rogers ID is capped) |
| Ophthalmology | Isolated ocular trauma or mass in patients with poorly controlled/significant medical comorbidities | Ophthalmology with a medicine consult |
| Ophthalmology | Isolated ocular trauma or mass in patients with stable medical comorbidities | Ophthalmology |
| Ortho | Septic joints in a medically non-complex patient | Ortho (may consult medicine after admission if evaluation for source is needed) |
| Ortho | Isolated operative extremity fractures in a medically non-complex patient with no indication of internal organ injury | Ortho (Trauma may be consulted but should not delay admission) |
| Ortho | Isolated operative extremity/pelvic fractures in a patient with stable medical problems that did NOT lead to the fracture (e.g. HTN, DM, CRI) | Ortho Trauma with General Medicine consult after admission [includes geri hip fx] |
| Primary Concern | Reason for Admission | Designated Team (in order of preference) |
|---|---|---|
| Ortho | Isolated operative extremity/pelvic fractures in a patient with active medical problems that did NOT lead to the fracture, but need medical treatment prior to fracture repair (e.g. AKI, severe hyponatremia, DKA) | General Medicine or Geri (>65) with an Ortho consult upon admission |
| Ortho | Isolated operative extremity/pelvic fractures in a patient with active medical problems that lead to the fracture (e.g. syncope, TIA, AMS as determined by ED attending) | General Medicine or Geri (>65) with an Ortho consult upon admission |
| Podiatry | Podiatry complications | Gen Medicine. Ortho if imminent surgery required (a level 1 or 2 case) or hemorrhagic complications. |
| Postop, NEW medical issue after surgical discharge (Non-Ortho) | New (but related) medical complications such as DVT/PE or Pneumonia following surgery | Gen Medicine if >14 days after surgical discharge |
| Postop, NEW medical issue after surgical discharge (Ortho) | New (but related) medical complications such as DVT/PE or Pneumonia following surgery | Gen Medicine if >48 hours after surgical discharge |
| Pulmonary | COPD exacerbation due to supplemental oxygen fire | Burn team |
| Pulmonary | Primary non-traumatic spontaneous pneumothorax/pneumomediastinum | Thoracic Surgery |
| Pulmonary | Non-traumatic pneumothorax/pneumomediastinum due to an underlying medical condition such as COPD or neoplasm excluding esophageal perforation | Medical/pulmonary team associated with the primary condition and a thoracic surgery consult as appropriate |
| Pulmonary | Patient on a home vent being admitted for a non-pulmonary issue and hemodynamically stable for a med/surg bed | Assign primary physician team per SDL, nursing care provided in an ICU or 5South bed (which unit determinted by the Patient Flow Center). The intensivist team may be consulted for vent overwatch. |
| Renal | A nephrology related illness but the patient isn't followed by a VMG nephrologist. | Renal (Medicine) |
| Renal | Dialysis shunt related complications due to infections | Renal Transplant (Surgery Renal Medicine) |
| Renal | Dialysis shunt related complications due to clotting | Renal if VMG patient, otherwise Gen or Subspecialty Medicine with Renal consult |
| Renal | ESRD with a nonspecific complaint such as fever or weakness without clear etiology. | ) |
| Primary Concern | Reason for Admission | Designated Team (in order of preference) |
|---|---|---|
| Return Patient | Patients discharged from a service but returning within 48 hours with a different complaint | ED determined - The discharging service unless extenuating circumstances |
| Sickle Cell | Sickle cell crisis with complications (acute chest, fever, PE, elev trop, hypoxia etc...) | General Medicine (Sickle Cell service if uncomplicated) |
| Spine | Chronic back pain with Spinal Cord Stimulation System | Gen Medicine |
| Spine | Degeneration (disc herniation, stenosis), not cauda equina | Gen Medicine |
| Spine | Infection | Inf Dis Medicine |
| Spine | Spinal stimulation system hardware failure or infection | Neurosurgery |
| Spine | Trauma (fractures) | Trauma (per established protocol) |
| Spine | Tumor | Spine Surgery (Ortho/NSG) |
| Surgical | Small bowel obstructions (non-IBD patients) | EGS unless palliative care or carcinomatosis |
| Surgical | Small bowel obstruction (in patient with known IBD) | Colorectal Surgery if complete SBO, otherwise Rogers GI (or GMD if capped) |
| Surgical | Primary psoas abscess | ID |
| Surgical | Potential surgical problems in a patient with multiple medical | Surgery with a medicine consult |
| Surgical | Secondary psoas abscess due to nearby infection (spine hardware, THA, AAA graft etc) | Team that manages the primary source of infection with EGS consult as needed |
| Surgical | Necrotizing Fasciitis | Ortho Trauma for extremities, Urology for groin, EGS for trunk or multiple areas |
| Toxicology | Intubated CO exposure | Burn ICU if from structure fire, otherwise MICU |
| Toxicology | Non-intubated CO exposure | Burn team if patient has cutaneous burns, otherwise Medicine with tox consult. If a family needs overnight 02 and has no other injuries the patients remain cohorted under EM management in the adult or pedsED |
| Transplant | Cardiac transplant patient | Determined by cardiac transplant attending |
| Transplant | Lung transplant patient | Pulmonary medicine unless a clearly surgical problem |
| Transplant | Liver transplant patient | HBS if <90 days post-transplant or a clearly surgical problem, otherwise hepatology |
| Designated Team (in order of preference) | Reason for Admission | Primary Concern |
|---|---|---|
| Renal transplant surgery if <30 days post-transplant or a clearly surgical problem, otherwise nephrology | Renal transplant patient | Transplant |
| Trauma T3 Service, except GenMed/Geri if: patient is $>65y/o$ or - has decompensated medical comorbidities or - needs a medical workup for the proximate cause of the injuries | Isolated non-operative extremity/pelvic fractures or patients needing admission for ADL's/pain control | Trauma |
| Trauma team | Complex neck lacerations | Trauma |
| Facial trauma on call team | Trauma to external ear (tragus, auricle) | Trauma |
| ENT | Trauma to external auditory canal, tympanic membrane, or middle ear | Trauma |
| Facial trauma on call team | Complex scalp lacerations | Trauma |
| Trauma if C-Spine fx or vasc injury, neurolCU team if intubated due only to anoxic brain injury | Hanging | Trauma |
| Plastics | Isolated large or complex soft tissue defects/lacerations from trauma or wound complications not involving bones | Trauma/Wound |
VUMC Operational Policy 10-20.05 Management of Emergent Transfers to VUMC
- Requests for transfers are coordinated through the Access Center.
- The Emergency Department (ED) attending or service specific accepting physician coordinates an appropriate transfer with the VUMC Access Center staff and the referring provider/facility. Any denial or delay of accepting an EMC transfer is escalated to the supervisor immediately. NOTE: The ED attending has the authority to accept patients.
- For patients that require hospital admission, it is the accepting physician or designee's responsibility to admit the patient or secure another admitting physician and primary service. If the patient was accepted by the ED that responsibility lies with the attending physician on the primary service designated by the ED.
- Patients accepted by the ED are assigned to a primary service by the ED attending. It is the accepting physician or designee's responsibility to admit and treat the patient, or to secure and transfer the patient to another admitting physician and primary service.
Policy Effective Date: August 2012, Passed by the Medical Center Medical Board June 2012
VUH Chief of Staff Office (2-1131)
Last Amended December 2018