Table 1

Key problems identified by small-group participants

1. Lack of trust between the emergency medicine and internal medicine departments.
2. ED faculty do not have admission privileges to all services equally.
3. Admitting officer on duty (an internal medicine resident) has too many clinical and administrative functions.
4. No clear roles or responsibilities once a bed request is placed.
5. Bolus of admissions existed at 7:00 and 19:00, producing predictable choke points.
6. Many patients admitted due to limited outpatient access for appropriate services.
7. The admission process degrades communication between admitting and evaluating services.
8. Patient surveillance by the ED decreases after hand-off.
9. Admitting internal medicine teams perform extensive evaluation in the ED before orders.
10. Uninformed perceptions about the speed and availability of ancillary and support services on the inpatient units.

  • ED, emergency department.