This page will discuss how to pre-admit patients properly before they have arrived to the hospital. It is important to note that this guide assumes that the user is using an EMR system such as EPIC. Also this guide also is meant for situations where a pre-admission/admission encounter has been created for the patient in question. If this encounter does not exist it is recommended to call the admitting department of the hospital and urge that department to create the correct encounter so the pre-admission process can begin.
WHY IS PRE-ADMITTING PATIENTS IMPORTANT?
It may seem overly aggressive to pre-admit patients before they have arrived in the hospital, so this guide begs the question why do I need to try and pre-admit patients before they are even in-house? The answer really is quite simple and will become evident to any provider who has managed a busy inpatient service: TO SAVE TIME AND GRIEF. The moment you become aware that a patient will be coming to your service there are clear steps that can be taken to expedite the admission process that will benefit not only the care team but the patient as well.
Often times what can happen is that if you don’t prepare any of the patient’s admission paper work they will arrive on your service when you very likely could be indisposed (in the operating room, running a code, taking care of other patients, using the restroom, etc) which will create challenges for everyone involved. You will begin to get paged about admission orders and this will create more work and slow down everything! If you utilize this guide effectively you will be able to do all of the preparations so that when the patient arrives to the hospital they will already…
- Show up on your patient list with an updated signout
- Have admission orders (such as labs etc)
- Have most of an admission note ready to go
Please take a look at the sections and the videos below that show how to pre-admit a patient. This page includes tutorial videos in each of its sections (that demonstrates how to conduct these techniques on the UCSF EPIC EMR system). All of these videos can be found in this folder here.
*While the preview feature for these videos may not work on certain mobile browsers, the videos can still be viewed if they are given time to load/the page is refreshed.
STARTING THE PROCESS: SELECTING THE CORRECT PATIENT ENCOUNTER
Often times providers will be skittish with regards to pre-admitting patients because they have had a bad experience in the past where they placed admission orders in the wrong encounter and then felt as though all of their pre-admit efforts were wasted (and led to extra work). This is a valid concern and it is incredibly important that the correct admission encounter be selected at the beginning of this process.
ADDING THE PATIENT TO THE LIST AND UPDATING THE HANDOFF
It is very useful to be able to add the patient to your service’s patient list so that when they arrive they automatically appear on the list. Whats more, it is excellent to be able to update the handoff the team uses so that once they do arrive they have information available to all the team members and everyone can easily learn/remember why this patient has come to the service.
PLACING ADMISSION ORDERS
Placing core admission orders in advance can really expedite the admission process for the patient so that when they arrive the nursing staff can begin to settle the patient in. This can also include diagnostic orders such as labs and possibly even imaging orders (depending on the clinical context). These orders can be “signed and held” and then released by the unit once the patient arrives.
PENDING THE ADMISSION NOTE
It is also possible to begin preparing the admission note/H&P prior the patients arrival so that certain pieces of the note can be flushed out prior to their arrival (such as elements of the HPI that can be learned form the chart). Those who are very savvy can also even begin starting a discharge summary that can be shared with others for future usage.
Page Updated: 06.23.2019