Figure 1.

Patient admission process from ED to IM floor. This hospital has designed an electronic signout communication process (e-signout) between EM physicians and admitting physicians through an electronic ED dashboard system. EM attendings decide on need for admission, notify admitting office. Admitting office assigns inpatient bed/team, notifies accepting IM physician via admission page. IM physician (either resident on teaching service, or hospitalist attending on non-teaching service) reviews e-signout and either accepts admission (86% of cases, in which case patient is transferred to IM service) or initiates discussion (14% of cases, in which case a “red MD” notification appears on dashboard and EM resident is notified of need for discussion). If “red MD” case, EM resident and IM resident/attending discuss concerns. If issue is resolved, patient is transferred to IM service. If not resolved, discussion rises to EM attending/IM attending telephone discussion (rare). Issue is either resolved and patient is transferred to IM service or disposition is changed.

EM, emergency medicine; IM, internal medicine; MRN, medical record number; ED, emergency department.