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Archive for the ‘Intake’ Category

Geri ED

Thank you for all your support, comments, suggestions and constructive criticism as we launched the Geriatric ED, a work in progress. The Geriatric Operations Team has revised the Geriatric ED/East Zone Guide attached which incorporates the lessons learned from the first week, your suggestions as well as a schedule which highlights the current available staffing resources for the Geriatric ED. Briefly:

Hours: Accepting New Patients: Monday-Friday 9am-9pm, Beds 23-32 Saturday-Sunday 11am-9pm Beds 29-32
Holding Obs or Admitted Patients that meet the Geriatric ED criteria: 9pm-9am (11am Sat/Sun) Beds 29-32

Capacity: Monday-Friday 8-14 patients (dependant on Patient:RN ratio 1:8)
Saturday-Sunday 8 patients

Criteria for Care and Observation:
Age >/= 65
ESI 3,4,5
Knows their name, oriented to Self
Ambulatory to bathroom before illness or injury, Walk

Attending: M-F Intake/South ED E2s Attending; Sat-Sun South/Fast Track Attending
Resident: T/Th/F ED Geriatrics
PA: M-F East/+/-CB; Sat-Sun Fast Track
RN: M-F East/+/- OT RN; Sat-Sun Fast Track
ER Tech: M-Sun East
BA: M-F East; Sat-Sun Fast Track
SW: M-F ED SW; Evenings, Sat-Sun Oncall SW

This Guide will replace the posted first draft in the Main ED and Geriatric ED. We welcome your input and will continue to revise it to best serve you and our patients going forward. Please feel free to speak to or send your questions, comments and suggestions to: or or


Gallane Abraham, MD

Written by phil

February 24th, 2012 at 10:25 pm

Updates on intake, east zone, fast track criteria

Median time to doc is up to 51 minutes, from 42.— we need to be 30 minutes!
LWBT is up—from 2.5% to 4.8%
Some of this is due to Epic, some due to flow issues…. Below is what we are going to do to address some of the problems.

1. Intake: nursing has committed to staffing intake mon-Friday 11a-11p with 3 nurses. This is a priority assignment and it will be filled
2. Intake: if you notice several ambulances at intake— let them know that one member of a crew can go to the intake, and one to the ambulance bay to arrive a pt in epic.
3. East: on July 18th we will be changing how the east zone is used: no admitted pts will go to East—it will be used for Observation pts, Gyn and Ortho care. “OGO” It will also be used for “after intake care”.
4. Fast track—below are the new FAST TRACK GUIDLINES– nursing is in the process of educating all RN’s on the new guidelines—go live date will be July 18th.

Thanks for you input and support

Kevin, Suzanne, Dwayne and Francine


-If brought by ambulance, must be able to get off of the stretcher and in to a wheelchair
-Only 2 asthmatics at one time, others must go to main ED
-Goal is to see and dispo pt in under 20 minutes

(VS: sat ,95%, HR<110, RR <22, BP < 160/100) -uri -minor laceration (less than 6cm) -abscess (not rectal or perirectal) -cough, -uti -uncomplicated ortho <65 y.o, no, IV meds or admission -digit dislocation, not requiring sedation -eye complaint -BBFE -cellulitis in otherwise healthy adult with normal VS -wound check/suture removal -rash -allergic reaction, skin involvement only (no respiratory symptoms) NO -obvious ortho deformity -if needs US or CT -if needs labs (other than POC, rapid HIV, repeat hcg quant) -ortho >65 y.o.
-fall >65
-code 11
-needs isolation
-OB/GYN complaint
-testicular pain
-active epistaxis
-dislocation that will likely require sedation (hip, shoulder, elbow)

Any patient that requires more care than is appropriate for the fast track area will be immediately relocated to the main ED treatment area and the ED physician and charge nurse will be notified

Kevin M. Baumlin

Written by reuben

July 6th, 2011 at 10:24 pm

Intake Zone Intro

The following areas need to be on your tracking board:

.Adult ER South (Hallway)
.Adult ER-North (Hallway)
.Waiting Room-Adult
.Waiting Room-East Zone
.Waiting Room-Peds
.Waiting Room-Peds Screening
.Waiting Room-West
Intake Area

The waiting room is your zone. You pluck out patients from the waiting room and either perform a brief or full evaluation.

Brief evaluation
a. Assign yourself to the patient
b. Introduce yourself and perform whatever elements of the history and physical exam are necessary to generate an initial plan.
c. Enter orders
d. Write a brief progress note in the chart. Example: “Patient briefly evaluated by me in intake area. Preliminary studies initiated; patient is pending full emergency evaluation.”
e. Un-assign yourself from the patient

Full evaluation

Identical to seeing any patient primarily; these patients are fully charted and dispositioned by you. If you discharge a patient from intake, dispo is not discharged, it’s “discharged from intake.”

Indirect admissions, i.e. patients referred to the ED not for an emergency evaluation but for admission to the hospital, are particularly good candidates for full evaluation at intake.

Which nurse performs initial orders depends on the relative flow of the nurses at intake vs. inside. If there are 20 patients waiting to be triaged, the priority of the intake RN is to evaluate those patients, not to perform orders for patients evaluated by the intake MD.

Patients who require an ECG get it in intake. For these patients, review the ECG, sign it, enter it into the chart. Pull up comparison ECGs yourself and print them out. Perform a brief evaluation. Give the ECGs to the patient to give to the next provider.

Refer as many patients to IMA as possible. These patients must be triaged and put into IBEX. Assign yourself, very briefly assess the patient, document “Medical screening exam performed.  Patient stable to be seen in clinic.” No attestation is necessary. Final diagnosis is “Sent to clinic.” Disposition is “Sent to clinic.”

Written by reuben

November 26th, 2010 at 6:14 am

Posted in Intake