Table 5.

Direct admission guideline components not endorsed as appropriate and necessary by multistakeholder panel^*

Appropriate but not necessary guideline components
Referring providers should have the following information available at the time they refer a patient for direct admission: The type of bed required for the admitted child (for example, crib, net bed) If hospitals do not have dedicated observation units, hospitals should develop a plan of care for patients anticipated to require short stays (ie < 8 hrs) for when that care can’t be provided by the referring provider Personnel from the admission office come to the patient’s room to complete admission processes at the bedside, so that families do not need to stop at the admission office en route to their hospital room Hospitals have a pre-admission system that allows orders to be placed for the patient in advance of their arrival Hospitals have a system to pre-order specific medications and supplies for a patient in advance of their arrival. To facilitate imaging for children who are directly admitted, hospitals should develop systems that allow children being directly admitted to have the same priority for imaging as children admitted through emergency departments (for example, requests for stat X-ray or CT can be accommodated for directly admitted patients) Children with cystic fibrosis may be particularly well-suited for direct admission to hospital. Families are given instructions about which hospital entrance to use, and where to find wheelchairs, if needed. Families are given clear instructions about where to park at the hospital
Guideline components categorized as neither appropriate nor necessary
Referring providers should have the following information available at the time they refer a patient for direct admission: i. Referring physician’s estimate re. how long the patient could safely wait before care is initiated in the hospital ii. Name and contact number of the parent/guardian who will be accompanying the child for admission Patients should have vital signs within normal ranges for age in order to be directly admitted Direct admissions are not accepted from non-pediatric referring providers (for example, non-pediatric ED physicians, nurse practitioners, or physicians assistants) unless an attending physician (ie not a resident) is available to see the patient within 4 hours of their admission to hospital A patient should have been seen by the referring provider within 4 hours of the requested direct admission In order to be directly admitted, patients must come directly from a physician’s office, ED or urgent care clinic Healthcare providers accepting the phone calls for direct admissions apply the Pediatric Early Warning System (PEWS) to information received from the referring healthcare provider to calculate a PEWS Children being admitted directly first have their vital signs assessed in the hospital’s emergency department and reviewed by the admitting physician prior to proceeding their admission location Hospitals should work to discharge patients early in the day to free up nursing resources for direct admissions later in the day Febrile infants < 60 days admitted to rule-out sepsis may be particularly well-suited for direct admission to hospital Families are given a map and/or clear written instructions describing how to get from the parking lot to the unit where their child will be admitted Outcomes to evaluate the quality of direct admissions include: length of stay in the hospital

^*although panelists rated each item separately for community hospitals and children’s hospitals, categorization of responses did not differ by hospital type