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Admission Slips
Reasons for delay in admission to ( Sp 3 ( Sp 4 ( Sp 5 ( ICU

( Unclear who is the accepting hospitalist

( Hospitalist requests delay in admission until next shift/provider

( Hospitalist requests the patient remain in ED until evaluated by hospitalist in person

( Hospitalist requests additional testing to determine decision to admit: ( consult ( labs ( imaging :____________

( Hospitalist requests additional testing after decision to admit is made with ED MD: ( consult ( labs ( imaging:______________

( Assigned bed is not ready because it is not: ( empty ( clean ( correct

( Nurse (med-surg-tele or ICU) is not available to take report

( Med-surg, tele, or ICU bed available for more than 30 minutes and report not called by ED nurse

Clerk initials _____________

This form is not part of the patient permanent medical record. This is a quality improvement worksheet. If found please forward to emergency department manager. |

Reasons for delay in admission to ( Sp3 ( Sp 4 ( Sp 5 ( ICU

( Unclear who is the accepting hospitalist

( Hospitalist requests delay in admission until next shift/provider

( Hospitalist requests the patient remain in ED until evaluated by hospitalist in person

( Hospitalist requests additional testing to determine decision to admit: ( consult ( labs ( imaging :____________

( Hospitalist requests additional testing after decision to admit is made with ED MD: ( consult ( labs ( imaging:______________

( Assigned bed is not ready because it is not: ( empty ( clean ( correct

( Nurse (med-surg-tele or ICU) is not available to take report

( Med-surg, tele, or ICU bed available for more than 30 minutes and report not called by ED nurse

Clerk initials _____________

This form is not part of the patient permanent medical record. This is a quality improvement worksheet. If found please
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