For surgical providers, the following document reviews the process for placing admission orders, including changes from the 2020 updates to UChart.
Prep for Surgery
BPA Alert
An alert appears after a case request order is signed with the following conditions:
- Procedure on CMS Inpatient-only List
- Patient not admitted
- Patient does not have an Admit to Inpatient order
The alert displays in the Best Practice section of all surgical navigators when entering orders connected with a surgical case.
The alert also displays when the chart is opened, during Order Entry and when filing to Doc Flowsheets by Physicians, Residents, APRNs, and Physician Assistants.
Please note: The order must be cosigned by attending surgeon within 48 hours of surgery.
Day of Surgery
On the day of surgery, several areas of the patient’s surgical chart contain additional information with regard to Admission orders:
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Multi-Provider Schedule
New columns appear on the provider Schedule indicating:
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Storyboard
Auth/Cert status has been added to surgeon storyboard.
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- If procedure on case is on Inpatient-only list
- If signed & held admission type order is present in chart
Procedure Pass Tasks
In the Pre-op Consult navigator, an Admit to Inpatient Procedure Pass task is added at case creation if case includes procedure on Inpatient-only List
The Task status is marked completed when order is entered
Releasing Admission Order
The alert also appears on the day of surgery in the Manage Orders activity, when the Pre-op Nurse releases the Admit to Inpatient Order under the Signed & Held tab when the patient’s class is updated to Inpatient
Co-Sign Admission Order
- Attending surgeon cosigns admission order within 48 hours of surgery.
- The Admit as Inpatient Order appears in the Orders to Sign section of the post-op navigator.
Push Notification
Push notification to be sent to primary surgeon at documentation of in pre-procedure event if patient does not have admit to inpatient order.
If entering Admit orders by select Accept in the BPA:
If entering Admit orders in Post-Op navigator:
Post-Procedure Admission Order Types
Post-procedure admission order types includes 4 options for all UM locations:
1. Admit as Inpatient
2. Extended Recovery
- Patients do not meet observation/admission criteria, but need monitoring beyond normal recovery period.
- They are still in recovery status, but may be monitored anywhere within the hospital.
3. Admit as Observation
- Patients meet InterQual observation criteria (eg. unexpected event during recovery period such as uncontrollable pain)
4. Non Medical Stay (Bedded Outpatient)
- Patients no longer require medical treatment and meet discharge criteria. They remain in an outpatient bed pending resolution of logistical issues (eg. transportation) at which time final discharge process (including medication reconciliation) will be completed.
5. Transfer Order
These orders have updated fields and instructions to assist in selecting the appropriate admission type, and are composed of two parts:
1. Bed request (immediately active)
2. Class and accommodation order (signed and HELD, will be released by nurse in the appropriate treatment location)
Please Note: Providers should not change the phases of care settings that are defaulted in these orders.
Admitting a patient as Inpatient
Admit As Inpatient is for patients who will require full admission to the facility for medical treatment for an overnight stay or longer to meet criteria for discharge. When required medical criteria are met, the final discharge process (including medication reconciliation) will be completed.
Providers must complete the following sections:
Placing a patient in Non-Medical Stay (Bedded Outpatient)
Non Medical Stay (Bedded Outpatient) is for patients who no longer require medical treatment and meet criteria for discharge; but who will need to remain in an outpatient bed as an accommodation – pending resolution of logistical considerations such as transportation, at which time the final discharge process (including medication reconciliation) will be completed.
Providers must complete the following sections:
Placing a patient in Extended Recovery
This is intended only for patients who do not meet the criteria of observation/admission and need to be monitored beyond the normal recovery period outside the PACU/recovery area. These patients are still in recovery status and may be monitored anywhere within the hospital.
This order has two components:
1. The first is a bed request which is immediately active; and
2. The second component is an order that will change the patient’s class and accommodation code to “extended recovery” and will become active when the order is released by the nurse in the area where the extended recovery monitoring is occurring.
Providers must complete the following sections:
Placing an Admit to Observation Order
Post Procedure patients that meet the 23-hour Observation Criteria (i.e. Inter-Qual criteria) will continue to need an “admit as observation” order.
Decision support tools in the form of a Best Practice Advisory (BPA) will alert providers that an order for Admission to Observation status should not be entered until the “normal recovery period” of four (4) hours has elapsed. During the “normal recovery period,” the provider can still enter other post op care orders for the patient.
For additional information regarding observation, inpatient or recovery criteria, please reach out to your facility case manager or utilization review.
Providers must complete the following sections:
Code Status must be documented on every admission.
1. Select the proper Diet/Nutrition for the patient.
2. Adding additional orders: click within the search box under Additional Orders.
3. Sign Orders for Admission.
Remember: These orders are not active on the patient’s chart until the receiving nurse releases them when the patient arrives on the receiving unit.
4. Once you have signed your orders you may close out the workspace by clicking the X next to the patient’s name.
UChart Tip Sheet Last Updated 12/3/2020
If you require additional assistance, please contact the UChart Help Desk at 305-243-5999, Option 2 or UChartHD@med.miami.edu.
