psychiatric population is the most difficult to place.
This practice extends into the Emergency Departments of both BC Children’s Hospital and the community centers. Decisions to turn a patient away from ED at BC Children’s is variable and depends on a number of factors but many discrepancies between physicians exist. The factors influencing Emergency Department admissions include: the ED physician’s comfort with community hospitals, and the diagnosis/stability of patient. The patient’s parent needs to agree. When a potential transfer is being considered, the Pediatrician speaks with families about this. The accepting hospital needs to agree with the transfer. It is possible that a patient swap might be arranged with outlying hospitals. A need to err on side of caution is important in these decisions.
The hospital has a Program Manager for Access and Utilization. She meets daily with senior residents after bed utilization meetings to discuss admissions, ICU potential transfers and tentative discharge dates on the inpatient units. She also emphasizes with residents and physicians – if there is no bed post-operatively, no surgery is possible. She shares the 6 month utilization reports with the management and physician groups. In stress times (ie when there are higher demands for beds than there are potential discharges) the next level is authority is the Medical Admitting Officer, a senior physician, who is able to facilitate early discharges in collaboration with his physician colleagues.
The out-lying Community hospitals set what they will accept. Examples are:
0 – 19 years
Reactive Airway Disease as long as they are qhourly Ventolin or less
Bronchiolitis depending upon acuity
Upper Respiratory Tract Infections
Urinary tract infection