1. Request for Social Hold in Pediatrics Policy Updates TX-383 Pam Sanders, MSN, RNC-NIC, CENP Vice President, Women & Children’s Services

2. Purpose:  To provide guidance for addressing requests for the admission or hold of a pediatric patient who does not meet medical criteria for inpatient or observation level of care

3. General Statements:  TGH employees & members of the medical staff are not responsible for performing the Children’s Multidisciplinary Assessment Team (CMAT) evaluations.  This is the sole responsibility of the Florida Department of Children and Family (DCF) Services or its legally designated agency.  Any child brought to the ED will receive a medical screening evaluation.  If no emergency medical condition exists which requires further observation or hospitalization, the patient will be discharged.

4. Requests for Social hold or admission of a child who is currently not a patient in the hospital:  Perform medical screening exam  Notify ED Manager or Clinical Admin Supervisor  Supervisor will notify NAOC and the Director of Case Management  If no emergency medical condition exists which requires further observation or hospitalization, the patient will be discharged Presents as a direct admit:  TGH will not accept direct admit requests via the Transfer Center or via direct communication to an admitting MD  Notify the Manager or Clinical Admin Supervisor & the NAOC  If no medical condition exists which requires observation or hospitalization, the patient will not be accepted Presents to the ED:

5. Requests for the Social Hold of a patient who is already an inpatient & now meets medical clearance for discharge:  If the Social Worker cannot place a patient in the custody of DCF with active discharge orders, immediately notify:  Manager of Social Work and/or Director of Case Management  Nurse Manager of the inpatient unit  Attending Physician  Vice President of Women & Children’s Services

6. Next Steps:  The Director of Case Management and/or Manager of Social Work will notify the legally designated agency for DCF and the Director of the Department of Children & Family Services to expedite placement.  The Director of Case Management will notify the Risk Management, AHCA and/or CMS of DCF’s inability to find placement

7. Daily Discussions:  Daily discussions will occur to discuss placement status until appropriate placement has been found.  Document all communications in the EMR.  Daily discussions will include (or designee):  Director of Case Management  Director of Risk Management  Legally designated agency for DCF  Inpatient unit NM  Vice President of WCS