New Admissions Changes

HMSL has changed the requirements for primary care physicians who admit patients through the Emergency Room or through direct admit.

Effective Oct. 26, new medical staff rules and regulations require med-surg patients to be evaluated and examined within the specified times below by their admitting physician (or covering physician). Advanced practice providers are no longer allowed to do the admission on behalf of the physician.

1. Two & Four Hour Rules:
   1. Med-surg: patients to be evaluated and examined within four hours upon arrival
   2. Obs & ICU: patients to be evaluated and examined within two hours upon arrival
2. Clock Starts:
   1. Upon patient arrival to their room for direct admission and transfers in​
   2. When the accepting physician receives notification via secured messaging system (e.g., PerfectServe, Epic) for admissions from our ER

If an admitting physician is unable to see his/her patient within the stated timeframes, the patient will be reassigned to the hospitalist service.

For patients admitted directly into the ICU, if their physician is unable to see his/her patient within two hours, the patient will be reassigned to the intensivist service. When a patient is downgraded to med-surg, the patient will be transferred back to the original attending physician, who will have four hours to evaluate his or her patient.

The new rules also impact transfers from other facilities, including free-standing ERs. Those patients will be considered direct admits, and if the accepting physician has not yet examined the patient, the two- and four-hour rules will apply. The only time these rules do not apply is if the physician has seen the patient in the clinic the same day as admission since the clinic visit is considered to the be the first visit at the bedside. In such cases a history and physical must accompany the admission orders.

The goal of these changes is to ensure that patients are evaluated promptly so that care can be delivered in a timely fashion. We believe these changes will allow for our patients to receive the highest quality of care and improve efficiency, care coordination and the patient experience.