Harbor:CORE

Who to call
  • Daytime ~8a-4:30p - CORE NP/Fellow - Orchid autopage (p1687)
  • Signout time ~4:30p-6p - CORE Fellow - Orchid autopage (p1687)
  • After 6p - Third Call Fellow - Orchid autopage (p6534)

Chappell, 2/2021

Background
  • Any OOP patients needing observation or CORE services should be transferred to an in-network hospital if they are stable - Peterson 5/2016
  • Only patients with internal medicine (or family medicine) covered illness can be placed on obs. All other services require admission (or transfer) - Lewis 5/2016
  • If the hospitalist is capped (cap is 20 if single overnight hospitalist coverage, which includes Obs and CORE leftover from dayshift, new Obs or CORE, and new admissions), and you have a patient you’d like to place in Observation, CORE, or an admission:
    • Do not place the order for obs placement, CORE, or the ‘request for admit’ order. This becomes confusing for nursing who is actually managing the patient. Only place this order when you have discussed the patient and the care officially transfers to the inpatient/obs/CORE physician.
    • Continue to manage the patient until the next hospitalist shift starts (typically 7:30am) or the next medicine slot is available.
    • Do put in an Attending Admit Note at the time of the actual admit decision but document in your notes that patient is being held in the ED due to lack of hospitalist/Medicine capacity.
  • Core idiosyncrasies
    • Admit for non-CHF edema, anasarca (abdominal or scrotal edema), or requiring significant diuresis (>10kg)
    • Psych can consult in CORE, or patient can be discharged from CORE to psych ED on patients requiring cardiac clearance


CHF
  • If estimated <2 midnight stay, place in CORE
    • Admit any patients with anasarca (including abdominal or scrotal edema)
  • If estimated >2 midnight stay:
    • Admit to IM/FM (tele/PCU) if all of the following are met:
      • Low suspicion for ACS (as determined by ED attending)
      • HR < 110
      • BP > 110
      • Creatinine <2.0 (unless ESRD on HD)
      • No BiPAP required at any time in the ED
    • Admit to C-team if the above criteria are not met or the patient needs ICU care

See Also

References
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