Home From The Editor The debate over direct admissions

The debate over direct admissions

March 2010

Published in the March 2010 issue of Today’s Hospitalist

In this month’s issue, we tackle a topic that hospitalists confront all the time: direct admissions. While I haven’t seen much attention devoted to direct admissions in magazines and journals, it’s certainly a contentious subject among hospitalists.

Put simply, the problem is that primary care physicians who don’t see patients in the hospital still want to be able to admit patients directly to the floor, in large part to spare them a long wait in the ED. That sounds like a good idea to hospital administrators, who are desperate to unclog their EDs.

But among hospitalists, the concept of direct admissions receives a decidedly mixed reaction. Some hospitalists contend that directly admitting some patients delivers more appropriate, faster care. But the opposite camp points to patient safety concerns and believes that making patients stop in the ED isn’t a barrier, but a safeguard.

Here’s one example from our story, which begins on page 24: A patient is directly admitted to the floor for chest pain but is found to be having a full-blown MI and needs to be shipped out for a cath. In that situation, a direct admission is not only bad for hospitalists, but for patients. The article also offers examples of direct admissions that are the right thing to do.

What makes our article particularly useful is that it sheds light on how some hospitalist groups are making direct admissions and rapid triage work. These solutions won’t work for everyone, but for hospitalists feeling pressure to take direct admissions, they may help.

I’d like to hear how you’re handling this issue in your hospital.

edoyleEdward Doyle
Editor & Publisher
edoyle@todayshospitalist.com