Common Inpatient Admissions - Revision history

JenniferH: /* Tuberculosis (TB) */

2020-11-10T19:43:25Z

Tuberculosis (TB)

← Older revision		Revision as of 19:43, 10 November 2020
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	Until the rapid TB assay (Xpert® MTB/RIF) is implemented sometime this year in 2015, it will take between 3-7 days to receive 3 AFB reports from the State Epi Lab (907-334-2100) to effectively rule-out infectious pulmonary TB depending on a number of factors. Generally, seek advice from one of our fine YKHC TB Control Officers (currently Elizabeth Roll, Ron Bowerman, Cindy Mondesir or Mien Chyi) or the State TB Officer, Dr. Michael Cooper (or his associated mid-level provider), before initiating therapy. T rapid TB sputum assay mentioned above will give more certainty and speed in clinical decision-making.		Until the rapid TB assay (Xpert® MTB/RIF) is implemented sometime this year in 2015, it will take between 3-7 days to receive 3 AFB reports from the State Epi Lab (907-334-2100) to effectively rule-out infectious pulmonary TB depending on a number of factors. Generally, seek advice from one of our fine YKHC TB Control Officers (currently Elizabeth Roll, Ron Bowerman, Cindy Mondesir or Mien Chyi) or the State TB Officer, Dr. Michael Cooper (or his associated mid-level provider), before initiating therapy. T rapid TB sputum assay mentioned above will give more certainty and speed in clinical decision-making.

	[[:~~Category~~:Inpatient]]
			[[:category:Inpatient\|Hospitalist Main Page]]

JenniferH: /* Tuberculosis (TB) */

2020-10-09T01:28:07Z

Tuberculosis (TB)

← Older revision		Revision as of 01:28, 9 October 2020
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	Until the rapid TB assay (Xpert® MTB/RIF) is implemented sometime this year in 2015, it will take between 3-7 days to receive 3 AFB reports from the State Epi Lab (907-334-2100) to effectively rule-out infectious pulmonary TB depending on a number of factors. Generally, seek advice from one of our fine YKHC TB Control Officers (currently Elizabeth Roll, Ron Bowerman, Cindy Mondesir or Mien Chyi) or the State TB Officer, Dr. Michael Cooper (or his associated mid-level provider), before initiating therapy. T rapid TB sputum assay mentioned above will give more certainty and speed in clinical decision-making.		Until the rapid TB assay (Xpert® MTB/RIF) is implemented sometime this year in 2015, it will take between 3-7 days to receive 3 AFB reports from the State Epi Lab (907-334-2100) to effectively rule-out infectious pulmonary TB depending on a number of factors. Generally, seek advice from one of our fine YKHC TB Control Officers (currently Elizabeth Roll, Ron Bowerman, Cindy Mondesir or Mien Chyi) or the State TB Officer, Dr. Michael Cooper (or his associated mid-level provider), before initiating therapy. T rapid TB sputum assay mentioned above will give more certainty and speed in clinical decision-making.

			[[:Category:Inpatient]]

JenniferH: /* Pyelonephritis */

2020-10-09T01:27:20Z

Pyelonephritis

← Older revision		Revision as of 01:27, 9 October 2020
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	All pregnant patients with a kidney infection should be admitted for initial treatment. Additionally, any patient who fails outpatient therapy or is unable to tolerate oral intake is a good candidate for admission.		All pregnant patients with a kidney infection should be admitted for initial treatment. Additionally, any patient who fails outpatient therapy or is unable to tolerate oral intake is a good candidate for admission.

			===[[Skin and Soft Tissue Infection]]===

			See YKHC Clinical Guideline for Abscess/Cellulits *link here and the [http://cid.oxfordjournals.org/content/early/2014/06/14/cid.ciu296.full#sthash.AnySZuMj.dpuf IDSA MRSA Guidelines].

			A Raven PowerPlan is available on Adult Admit Orders and Wound Care is automatically consulted as is Pharmacy for vancomycin management. Lower extremity abscess and/or cellulitis patients should have a VERY LOW threshold for admission.

	===[[Tuberculosis (Active and LTBI)\|Tuberculosis (TB)]]===		===[[Tuberculosis (Active and LTBI)\|Tuberculosis (TB)]]===

JenniferH: /* Abcess and Cellulitis */

2020-10-09T01:27:02Z

Abcess and Cellulitis

← Older revision		Revision as of 01:27, 9 October 2020
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	~~===Abcess and Cellulitis===~~

	~~See YKHC Clinical Guideline for Abscess/Cellulits *link here and the [http://cid.oxfordjournals.org/content/early/2014/06/14/cid.ciu296.full#sthash.AnySZuMj.dpuf IDSA MRSA Guidelines].~~

	A Raven PowerPlan is available on Adult Admit Orders and Wound Care is automatically consulted as is Pharmacy for vancomycin management. Lower extremity abscess and/or cellulitis patients should have a VERY LOW threshold for admission.

	===[[Acetaminophen Overdose]]===		===[[Acetaminophen Overdose]]===

JenniferH: /* Tuberculosis (TB) */

2020-10-09T01:26:15Z

Tuberculosis (TB)

← Older revision		Revision as of 01:26, 9 October 2020
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	All pregnant patients with a kidney infection should be admitted for initial treatment. Additionally, any patient who fails outpatient therapy or is unable to tolerate oral intake is a good candidate for admission.		All pregnant patients with a kidney infection should be admitted for initial treatment. Additionally, any patient who fails outpatient therapy or is unable to tolerate oral intake is a good candidate for admission.

	===Tuberculosis (TB)===		===[[Tuberculosis (Active and LTBI)\|Tuberculosis (TB)]]===

	If you suspect Active PULMONARY TB, then the patient should already be on Airborne Precautions* prior to arrival on Inpatient. This is also true if you order an AFB smear. Please see the YKHC Clinical Guidelines for TB, the Tuberculosis Book in the Doc’s Office and the Raven PowerOrders for this.		If you suspect Active PULMONARY TB, then the patient should already be on Airborne Precautions* prior to arrival on Inpatient. This is also true if you order an AFB smear. Please see the YKHC Clinical Guidelines for TB, the Tuberculosis Book in the Doc’s Office and the Raven PowerOrders for this.

JenniferH: /* Pneumonia */

2020-10-09T01:25:45Z

Pneumonia

← Older revision		Revision as of 01:25, 9 October 2020
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	Feel free to consult with ANMC IM for both clinical help and any f/u needs. Follow-up with their PCP is also key to preventing re-admissions.		Feel free to consult with ANMC IM for both clinical help and any f/u needs. Follow-up with their PCP is also key to preventing re-admissions.

	===Pneumonia===		===[[Pneumonia – Adult\|Pneumonia]]===

	See YKHC Clinical Guidelines for this (includes PSI-Pneumonia Severity Index to guide on who needs admission) as well as the Raven PowerPlan. RT should be consulted on all such patients regardless of supplemental oxygen needs. Also be cognizant of CMS discharge recommendations for this diagnosis posted in the NWing Doc’s Office (important for billing).		See YKHC Clinical Guidelines for this (includes PSI-Pneumonia Severity Index to guide on who needs admission) as well as the Raven PowerPlan. RT should be consulted on all such patients regardless of supplemental oxygen needs. Also be cognizant of CMS discharge recommendations for this diagnosis posted in the NWing Doc’s Office (important for billing).

JenniferH: /* Diabetes */

2020-10-09T01:25:02Z

Diabetes

← Older revision		Revision as of 01:25, 9 October 2020
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	See YKHC Clinical Guidelines for this as well as the Raven PowerPlan. RT should be consulted on all such patients regardless of supplemental oxygen needs. Also be cognizant that, like pneumonia above, this is one of CMS’s “high profile” illnesses and the CMS discharge recommendations for this diagnosis-includes EF and weight monitoring-is posted in the NWing Doc’s Office (important for billing). The known LV function (Ejection Fraction [EF]) for these patients is very important to document and if not available in Raven is often hiding in the old soft chart, RPMS-HIS Patient Chart, or online through ANMC. If this is a new CHF patient or no recent echocardiogram is in the record, a referral to Cardiology either through YKHC Specialty Clinic or at ANMC should be sent. Feel free to directly call the cardiologist at ANMC most familiar with the patient as needed or sometimes, especially during the weekend, IM will have to do.		See YKHC Clinical Guidelines for this as well as the Raven PowerPlan. RT should be consulted on all such patients regardless of supplemental oxygen needs. Also be cognizant that, like pneumonia above, this is one of CMS’s “high profile” illnesses and the CMS discharge recommendations for this diagnosis-includes EF and weight monitoring-is posted in the NWing Doc’s Office (important for billing). The known LV function (Ejection Fraction [EF]) for these patients is very important to document and if not available in Raven is often hiding in the old soft chart, RPMS-HIS Patient Chart, or online through ANMC. If this is a new CHF patient or no recent echocardiogram is in the record, a referral to Cardiology either through YKHC Specialty Clinic or at ANMC should be sent. Feel free to directly call the cardiologist at ANMC most familiar with the patient as needed or sometimes, especially during the weekend, IM will have to do.

	===Diabetes===		===[[Type 2 Diabetes\|Diabetes]]===

	It is reasonable to admit a diabetes patient with out of control blood sugars for glucose monitoring, medication adjustment, and education.		It is reasonable to admit a diabetes patient with out of control blood sugars for glucose monitoring, medication adjustment, and education.

JenniferH: /* CHF */

2020-10-09T01:24:21Z

CHF

← Older revision		Revision as of 01:24, 9 October 2020
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	See YKHC Clinical Guidelines for this as well as the Raven PowerPlan. RT should be consulted on all such patients regardless of supplemental oxygen needs. RT has been encouraging us to use Spiriva (tiotoprium) in favor of ipratropium as well as adding Advair on all such patients inpatient (and out outpatient as well). Albuteral nebulized orders for less than Q4hrs should be a rarity and CPAP use is very much an exception and if used at all, should only be for short periods. Patients requiring BiPAP cannot be admitted to NW.		See YKHC Clinical Guidelines for this as well as the Raven PowerPlan. RT should be consulted on all such patients regardless of supplemental oxygen needs. RT has been encouraging us to use Spiriva (tiotoprium) in favor of ipratropium as well as adding Advair on all such patients inpatient (and out outpatient as well). Albuteral nebulized orders for less than Q4hrs should be a rarity and CPAP use is very much an exception and if used at all, should only be for short periods. Patients requiring BiPAP cannot be admitted to NW.

	===~~CHF~~===		===[[Congestive Heart Failure]]===

	See YKHC Clinical Guidelines for this as well as the Raven PowerPlan. RT should be consulted on all such patients regardless of supplemental oxygen needs. Also be cognizant that, like pneumonia above, this is one of CMS’s “high profile” illnesses and the CMS discharge recommendations for this diagnosis-includes EF and weight monitoring-is posted in the NWing Doc’s Office (important for billing). The known LV function (Ejection Fraction [EF]) for these patients is very important to document and if not available in Raven is often hiding in the old soft chart, RPMS-HIS Patient Chart, or online through ANMC. If this is a new CHF patient or no recent echocardiogram is in the record, a referral to Cardiology either through YKHC Specialty Clinic or at ANMC should be sent. Feel free to directly call the cardiologist at ANMC most familiar with the patient as needed or sometimes, especially during the weekend, IM will have to do.		See YKHC Clinical Guidelines for this as well as the Raven PowerPlan. RT should be consulted on all such patients regardless of supplemental oxygen needs. Also be cognizant that, like pneumonia above, this is one of CMS’s “high profile” illnesses and the CMS discharge recommendations for this diagnosis-includes EF and weight monitoring-is posted in the NWing Doc’s Office (important for billing). The known LV function (Ejection Fraction [EF]) for these patients is very important to document and if not available in Raven is often hiding in the old soft chart, RPMS-HIS Patient Chart, or online through ANMC. If this is a new CHF patient or no recent echocardiogram is in the record, a referral to Cardiology either through YKHC Specialty Clinic or at ANMC should be sent. Feel free to directly call the cardiologist at ANMC most familiar with the patient as needed or sometimes, especially during the weekend, IM will have to do.

JenniferH: /* Alcohol related/Withdrawal */

2020-10-09T01:23:20Z

Alcohol related/Withdrawal

← Older revision		Revision as of 01:23, 9 October 2020
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	AMS patients with normal vital signs and no overt etiology for symptoms may be monitored inpatient in consultation with ANMC Internal Medicine.		AMS patients with normal vital signs and no overt etiology for symptoms may be monitored inpatient in consultation with ANMC Internal Medicine.

	===Alcohol ~~related~~/Withdrawal===		===[[Alcohol Hangover/Withdrawal]]===

	See YKHC Clinical Guidelines-p.20 as well as the Raven PowerPlan (also includes our Ativan Protocol) for this type of admission. Anyone hallucinating following cessation of alcohol ingestion should be admitted for Withdrawal and placed on the Ativan Protocol.		See YKHC Clinical Guidelines-p.20 as well as the Raven PowerPlan (also includes our Ativan Protocol) for this type of admission. Anyone hallucinating following cessation of alcohol ingestion should be admitted for Withdrawal and placed on the Ativan Protocol.

JenniferH: /* Behavioral Health / Title 47 */

2020-10-09T01:22:53Z

Behavioral Health / Title 47

← Older revision		Revision as of 01:22, 9 October 2020
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	If an anemic patient is symptomatic, they can be admitted for a blood transfusion.		If an anemic patient is symptomatic, they can be admitted for a blood transfusion.

	===Behavioral Health / Title 47===		===Behavioral Health / [[Title 47 Hold]]===

	See YKHC Clinical Guidelines as well as the Raven PowerPlan for this type of admission. BH manages these four closed-circuit monitored beds in two rooms which are cohorted by gender and behavior. The Title 47 part is a special Alaska law which allows a police officer, physician or psychologist to temporarily take a person rights away (for good cause) if there is perceived threat to self or others. There is an outpatient form that is generally signed to transport the patient to the ER prior to admission and a required pre-checked order sentence in the Power Plan for T-47 (that allows up to get paid for the admission) before the patient will be allowed on NWing. WE as the physician admit and discharge the patient while the BH Clinican generally deals with the BH aspects works with the patient to move them where they need to go to for the best care. Physician-BH Clinician communication is essential for the best care of these patients.		See YKHC Clinical Guidelines as well as the Raven PowerPlan for this type of admission. BH manages these four closed-circuit monitored beds in two rooms which are cohorted by gender and behavior. The Title 47 part is a special Alaska law which allows a police officer, physician or psychologist to temporarily take a person rights away (for good cause) if there is perceived threat to self or others. There is an outpatient form that is generally signed to transport the patient to the ER prior to admission and a required pre-checked order sentence in the Power Plan for T-47 (that allows up to get paid for the admission) before the patient will be allowed on NWing. WE as the physician admit and discharge the patient while the BH Clinican generally deals with the BH aspects works with the patient to move them where they need to go to for the best care. Physician-BH Clinician communication is essential for the best care of these patients.