Is your patient sick enough to admit?

1/6/2013

Is your patient sick enough to admit?

     For those of us that admit our own patients, we are always in a battle between case managers, utilization review, and our desire to provide the best care possible for our patients. Do you admit to observation, or do you do a full admission? Exactly how can we tell if our patient should be an “observation” status or a “full admission”?

     I am going to give you some “magic numbers for admission” from utilization review. This is by no means an all inclusive list, but it should give you some insight into how you patient should be admitted. These criteria are basically, “How sick is your patient?”

 1) Generally speaking, the condition should have an onset in the last 24 hours

 2) VITAL SIGNS

                Temp < 91 or > 106 (105 if patient is over 65)

Pulse- generally < 60 with symptoms or ? 3 second pause or >120 with arrhythmia +/- hemodynamic instability

Resp - >35 or impending intubation

SBP < 90 (only if decreased from baseline) or postural drop of > 30 or hypertensive emergency (sx or end organ damage)

SaO2 < 89%

 3) LABS

                WBC      > 16,000 (12,000 if suspect sepsis) or

< 4,000(if you suspect sepsis) or

Bands > 10%

                                Hgb < 6.0  Hct < 18%

                                Hgb < 8.3 Hct < 25% = age > 65

                                Plts < 60,000

                                Na < 120 or > 160 (with mental status changes)

                                K < 2.5 or > 6.0 with neuromuscular or ECG changes

                                BUN > 45

                                Cr > 3.0

                                Ca < 5.0 or > 15

                                Mg < 1.0 or > 3.0

                                Phos < 1.0

                                Acetaminophen > 300 + AST > 1000

                                Carboxyhemoglobin > 40%  or > 30% with mental status changes

WHAT ARE YOU DOING FOR YOUR PATIENT THAT CAN”T BE DONE AT HOME?

                Vital signs q 4 hours ( NOT q shift / while awake)

                Neuro checks q 4 hours

                IV fluids > 75 mL/hr

 IV meds _ antibiotics, proton pump inhibitor, insulin, steroids, pain meds (3X24 hours), diuretics (2X24 hours), anti-emetics (<3/24 hours)

Nebulizer Tx q 2 hours

O2 > 40%

Blood transfusion (>3 or 4 units/24 hours)

Chest tube TO SUCTION

GI suction

Hope this helps give you an idea as to whether it is an OBS or FULL admit. Unfortunately, as you can see even the guidelines "aren't sure".