Answers to your burning questions

• The main zone physician will get all of the RVUs for patients coming from NG to the CDU. 

• The Main Zone Physician will be responsible for completing an ED evaluation and complete note on all patients coming from NG to the CDU.

• Patients will physically go directly to the CDU

• THE MAIN ZONE ED PHYSICIAN WILL BE ASSIGNED ALL OF THE RVUs FOR THE PATIENTS' ED CARE (including NG).

• The documentation burden here is not minimal. However, This is good news! The SJH ED Main Zone physician will get a full patient's RVUs for a history and workup that has largely already been completed by another excellent board certified emergency physician. 

• The main zone physician will get ALL OF THE RVUs for patients transferred from NG to the CDU. 

Which patients may be direct transferred?

ED Patients seen in the Northglenn ED may be direct transferred to the SJH CDU IF:

• Require NO FURTHER ED WORKUP (except when testing is explicity discussed in the protocol, e.g. Back Pain > MRI) 

• Clearly fit one of the Established CDU Protocols (no edge cases)

• Patients agrees with transfer

Northglenn ED Physician Tasks

Once it is determined by the Northglenn physician that they have a good patient for CDU they should follow the following steps

• Use First Call to Contact the CDU PA or NP (between 8 am and 7 pm) and discuss the case

• Outside of CDU Hours, use First Call to contact the ED Physician at the St Joes ED. It would be wise to pull up the schedule and pick the physician who has the most time left in their shift

• Arrange transport using first call

• Complete your note. Make sure to include the CDU plan in the note using the ".iescduacutezoneplan" dot phrase. This should be used regardless of the time of day. 

• Complete a Medication Rec.  See Med Rec tutorial here 

CDU PA or NP Task Prior to Arrival 

Once you have discussed and accepted a patient for transfer to CDU please complete the following

• Tell CDU Nursing about the expected patient. 

• Tell the charge nurse so he/she can account for census. 

• Figure out which main zone physician has the most time left in their shift, start an EPIC chat with them. Make sure to attach the patient to the chat. Alert them of the expected patient.   Verbally telling them would be nice too. 

• Anxiously await their arrival. 

Patient arrives and physically is brought directly to CDU. They do not stop in the main zone.*

SJH Main Zone Physician Task on patient arrival 

When the patient arrives in the CDU (regardless of time of day) please complete the following tasks

• Physically go to see the patient in their room. 

• Complete an exam and note any abnormalities

• Confirm the history as documented in NG Physician Note

• Review the CDU plan as documented in the NG Physician Note

• Write a COMPLETE ACUTE ZONE Ed Note for the patient. This is your billing document. You will be assigned RVUs accordingly.  

• DO NOT use the "Transfer of care note".  Make a fresh ED Acute Note. 

• Discuss any concerns or changes to plan with the CDU PA or NP

IF the patient arrives after 7 pm 

• Enter the appropriate orders, including status orders and ED Observation Order set (Don't forget your PRNs) for the patient based on their condition and your professional assesment.

• Order any home medications based on the med rec completed by the NG Physician.

• Sing the patient a lullaby

• Obviously if they have become unstable during transport, they should go to the main zone instead. This should be rare.