KCH Admission Guidelines

The following guidelines specify which inpatient service will be primarily responsible for the admission of patients according to diagnosis. The list of diagnoses is not a complete one, and the guidelines are intended to be used flexibly. Patients should be admitted to the most appropriate service based upon the primary presenting problem/diagnosis.

In all cases, the Emergency Department (ED) physician is expected to conduct an evaluation sufficient to ascertain the need for admission, determine the appropriate admitting service, and identify significant medical comorbidities if they are present. The ED physician has discretion to interpret the guidelines in a way that best serves the patient. Discussions about the appropriate service should never take place in front of the patient, and decisions should be made collaboratively, professionally, and in a patient-centered manner.

Disagreement / Escalation

In the case when a service disagrees with an ED Attending’s plan to admit the patient to its service, the chief resident of the service in question may briefly and professionally discuss the case with the ED attending. If a disagreement as to the appropriate service persists, the Attending on the receiving service may call the ED Attending directly to discuss the decision. The ED Attending will allow 30 minutes for discussion to take place. If an attending is not available for discussion within this timeframe, the ultimate decision on admission and admitting service will remain the decision of the ED Attending. If the Attending on the receiving service believes that a patient would be better served on a different service but does not fit within the criteria outlined in this document, the Attending on that service may contact the responsible Attending of the other service to discuss placement – the disposition must be agreed upon within 30 minutes.