If patient is sent to ER: If patient is sent to floor: STC provider evaluates pt in STC, makes decision to admit STC provider discussed admission with ward fellow/attending who agree to take admission STC provider enters in ORCHID order “consult to UR”, entered on Infusion Center FIN STC team does this: Ward team does this: UR calls back by phone to STC provider with preadmit FIN STC provider enters a “REQUEST FOR BED” order on the preadmit FIN, identifying the H/O ward team as the care team Ward team evaluates patient in STC Ward team does not enter admit orders UNTIL bed location is identified and available (ie, room is empty, cleaned, and RN ready to accept report)--- Once bed is assigned, H/O Ward team enters admit orders on preadmit FIN STC provider informs H/O Ward team of the preadmit FIN HOWEVER: these orders will be lost the moment the Infusion Center FIN is cancelled either by (a) the activation of the preadmit FIN (which happens at admission) or (b) transfer of the patient to the ER and generation of an ER FIN Ward Team may identify additional interventions while patient is in STC before transfer (e.g., cultures, fluids, antibiotics); these orders are entered in ORCHID on Infusion Center FIN STC provider may identify additional interventions while patient is in STC before transfer (e.g., cultures, fluids, antibiotics); these orders are entered in ORCHID on Infusion Center FIN If a bed is not assigned by 3 pm, the patient will be transported from STC to the ER If patient is sent to ER: If patient is sent to floor: STC provider calls ER physician, presents case which needs to be transferred to ER, identifies the H/O Ward team as the accepting team, and does verbal handoff of any ongoing treatment plans on the Infusion FIN Ward team enters admission orders on the preadmit FIN (which is ‘flipped’ to the inpatient FIN when the patient arrives on the floor Pt is transported to assigned bed Admission orders entered on preadmit FIN are activated Immediately upon registration in the ER, an “ER FIN” will be generated The preadmit FIN and all attached orders will disappear The Infusion Center FIN and all attached orders will disappear Handoff check list: Orders for blood tests, cultures, and/or imaging studies ordered in STC on infusion Center FIN: were they done? Any critical signs/symptoms/VS which need monitoring? e.g. did the tachycardia respond to IV fluid bolus? Does the floor RN see all of the medication orders? The floor RN’s cannot see medications started in STC or prior MAR medicatons; verify critical medications (e.g., antibiotics for patients with SIRS/SEPSIS) Ward team waits for the ER FIN to be generated, and then writes admit orders on the ER FIN Ward team signs out the pt in the ER to the cross cover team