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Hi Beth, senior PA holds the admit pager and distributes admits based on census (list with lowest census gets first admit), sometimes that PA is extra that day and just does admits, sparing admits for PAs who have lists (unless a bunch of admits come in at the same time). My hospital has tried unit based lists, localization, "Onc list", "palliative list", but just doesn't work with logistics and movement of the hospital therefore their is no rhyme or reason as to which Pt goes goes to which list - that is for the non stepdown lists, general floor Pts - NYC large academic center. A few of us more senior do cover a few separate lists with higher acuity Pts (me personally a co-management list with Ortho Pts where we act as peri-op consult), these are unit based and localized, considered part of the Hospitalist service I'm on but not part of the main 10-11 lists of general floor Pts I first mentioned. Hope this makes sense, I can clarify if needed.

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  • 1 month later...

Basically, we have a "doc of the day" who is responsible for triaging admissions requests from the ED, outside direct transfers, and ICU transfers to the medical services (we have 14 medical lists, each carrying a census of 14-16 patients typically). It's based on a mixture of census and geography. Several of the services are for special populations, so sometimes it's based on those criteria as well. We have a rotating team of admitters (PAs, NPs, and MDs) who do all of the admission work, leaving the rounding teams free to focus on the established patients. When the admission is complete, the patient is signed out to the primary hospital service.

We don't really have a "step down" unit, but one of our services does take a capped number of those patients depending on acuity and bed needs in the medical ICU.

Each service is run by a physician and an NP/PA who split the census evenly between them.

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