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Archive for April, 2011

Admission Guidelines: Orthopedics vs. Medicine

From: Chang, Dennis [mailto:dennis.chang@mountsinai.org]
Sent: Fri 2/18/2011 5:45 PM
To: Chasan, Rachel (MSSM-Imail); Sadikot, Sean; Matloff, Jeremy (MSSM-Imail); Sachdev, Darpun (MSSM-Imail)
Cc: # DHM Hospitalists; # HMP NP (MSH)
Subject: Orthopedics Admission Guidelines

Evening,

So we met with the orthopedics department and attached are the guidelines for admission to medicine and orthopedics. A copy was given to the MAR today but if you guys could distribute this to all the MARs going forward that would be great. The orthopedics residents also received an email today. There was some confusion over the guidelines today but that was because the orthopedic residents didn’t read the guidelines thoroughly. This was cleared up today but there may be some confusion in the future. Thanks! Have a good weekend.

Dennis

Dennis Chang, MD
Co-Director, Medicine-Geriatrics Clerkship
Director of Medical Consult and Peri-Operative Services
Assistant Professor, Division of Hospital Medicine
Mount Sinai Medical Center

Orthopedic Admission Guidelines

Situations in which patient in ED with primary Ortho complaint should go to Medicine Team with Ortho Consult:
o ACUTE CHEST PAIN (for rule out MI, requiring Telemetry)
o ACUTE STROKE (Medicine or, more likely, Neurology)
o SYNCOPAL EPISODE CAUSING FALL (for rule out MI, requiring Telemetry)
o Hypertensive urgency (requiring Telemetry, IV antihypertensive drips)
o Severe ELECTROLYTE DISTRUBANCE (e.g. Hyponatremia)
o Other unstable comorbid condition (e.g. significant COPD or CHF exacerbation) not listed above

Situations in which patient in ED with primary ortho complaint should go to Ortho Team with Medicine Consult:
o ANTICOAGULATED PATIENT
o PTS NEEDING CARDIAC WORKUP PRIOR TO SURGERY
o MULTIPLE COMORBIDITIES (>5) RENAL, PULMONARY, CAD, CHF, DM, HIV – ALL OF WHICH ARE CONSIDERED STABLE AT THE TIME OF ADMISSION
Orthopedic Admission Guidelines

Written by reuben

April 22nd, 2011 at 6:01 am

Posted in Admitting,Ortho

Medicine Admissions Minimum Tests and Procedures

In order to ensure prompt, safe, and efficient throughput from the Emergency Department to the medicine department, the following have been agreed as the minimum required tests or procedures prior to admission to the department of medicine.

ALL admissions require:

• Venous panel
• CBC

Patients with fever:

• Chest X-ray
• Urinalysis

Patients with chest pain or shortness of breath:

• Chest X-ray
• Troponin
• ECG

Patients with abdominal pain:

• Abdominal panel (this may be pending but not resulted at time of triage to medicine)

Patients taking anticoagulants (coumadin)

• PT/INR

Patients with liver cirrhosis and ascites need a cell count for ascitic fluid before triage if any of the conditions below are met:
• Massive ascites in need of a large volume paracentesis
• Acute kidney injury
• Confusion
• Fever
• Abdominal pain

Written by reuben

April 14th, 2011 at 7:46 pm

Posted in Admitting