WHEREAS typical emergency physicians do not provide practice inpatient medicine;
WHEREAS admitted patients benefit by one primary physician orchestrating a treatment plan and by these orders being scrutinized by the nurse that will initiate those orders;
WHEREAS emergency department nurses, due to increasing patient volumes and nurse shortages, rarely have sufficient time to transcribe admitting orders;
WHEREAS there is often a time interval between admission and the admitting physician writing or relaying hospital inpatient admission orders;
WHEREAS patient treatment should be a continuous process despite any time gap between admission and completion of hospital inpatient admission orders;
Therefore be it resolved that the American Academy of Emergency Medicine believes that, in the interest of patient care, hospital inpatient admission orders should be formulated by the admitting physician and relayed directly to the primary inpatient nurse who will care for the patient.
The Academy believes that it is acceptable for emergency physicians to write Holding Orders, which define any necessary treatment and assessment parameters required in the interval until completion of admission orders.
The Academy encourages hospitals to create policy that ensures a short interval for completion of inpatient admission orders.
Supplemental Information
Example of Holding Orders
Admit Type
- Unit/ward
- Status (e.g., observation, full)
- Diagnoses
- Isolation (if necessary)
Responsible Parties
- Attending
- Resident Service
- Consultants
"Status Quo" Parameters
- Activity (e.g., bedrest or BRPs with assistance)
- NPO (motivates nurse to get further orders)
- Ventilator settings/Supplemental O2 (if necessary)
- Saline lock or IVFs (fluid/rate)
- Medications (drip rates)
- Vitals per unit routine (can include special assessments like neuro checks)
"On-notice" Directives
- Notify resident service/admitting attending upon arrival to floor
- Notify resident service/admitting attending if any abnormal vital sign/other condition change
- Call hospital medical director if full admission orders not written with 4 hours
- Above orders are limited to a 4 hour time period
Approved: 11/13/01