ADT is Epic's system for tracking inpatient visits from their arrival (admission), to their movements inside the hospital (transfer), to their departure (discharge). Unit Manager is used by inpatient nursing staff to manage patient movement and bed availability.

Resources

The following resources provide information on ADT functionality.

Overview and Admission

• Admission from the Unit Manager - (Handout) When a patient arrives in the unit, the NUC/RN will complete the admission process. This is NOT to be completed until the patient is physically on the unit.
• Admission Bed Request Order - (Handout) An Admission Bed Request order, that includes level of care, is required before Bed Planning to a UI Healthcare unit can occur. Providers are responsible for placing this order, but in the event the provider cannot place the order in a timely fashion, the ATC Nurse can accept a verbal order to initiate the placement of the Admission Bed Request order.
• Admission Bed Request - Ambulatory Clinics - (Handout) When a UIHC ambulatory clinic provider determines that a patient requires admission to the UIHC, an Admission Bed Request order with level of care is required before Bed Planning to a UI Healthcare unit can occur. The bed request order will trigger the Admission & Transfer Center (ATC) to find a bed for the patient.
• ADT Bed Types - (Handout) Epic now allows for defined Bed Types to be managed and requested both through the Unit Manager activity and the ordering process.
• Bed Swap - (Handout) Use the Swap option from the Unit Manager activity toolbar to swap two patients between rooms/beds without discharging or transferring either patient in Epic.
• Documenting Preferred Language and Indicating Interpreter Needs - (Handout) A Preferred Language must be documented for all patients. Interpreter needs should also be documented for patients in Registration.
• Event Management Quick Reference Guide - (Handout) Event Management is used to edit and update specific admission information that changes throughout a patient stay to ensure billing is accurate. Data items that can be edited via Event Management include: Admission Date/Time, Attending Provider Date/Time, Admitting Provider, Patient Class, Service, and Accommodation Code.
• Leave of Absence (LOA) for MCD Nursing Staff - (Handout) Leave of Absence (LOA) provides the ability to pause the patient’s MCD admission then resume that admission later, without discharging and readmitting the patient.
• Private Encounter - (Handout) The Private Encounter field within an encounter is used to document a patient’s request to opt out of the facility directory.
• Set the Notify PCP Preference - (Handout) Event notifications alert the provider that the patient has received care at a different setting. If the patient expresses a desire to not have event notifications sent, staff can indicate that preference on the Admission or ED Update form.
• Unit Manager Overview - (Handout) The Unit Manager organizes and provides access to all tasks required to manage a patient's ADT status.
• Unit Manager Move Column - (Handout) The Move column on inpatient unit managers provides additional information on the patient’s status when transferring to or from the unit.

Transfer and Transport

• Admitted Patient Not Returning to Old Bed Following Procedure - (Handout) When clinician places case request order for a procedure and indicates that patient will not return to their old bed.
• Adding and Removing Bed Blocks - (Handout) Bed Blocks are used in the bed planning process to prevent users from assigning a patient to a particular bed. Blocks warn those trying to admit or transfer patients to a bed about issues related to courtesy, census, isolation, infection, and maintenance.
• Approve, Reject, and Complete Transfer - (Handout) When a patient displays within the “Incoming Transfers” section of the Unit Manager, Unit Clerks and Nurses can approve or reject those transfers and assign the destination room / bed intended for the patient.
• Bed Requests (Transfer Patient)- (Handout) Once it has been determined that a patient needs to transfer to another unit, the provider places a Transfer Patient order. If the patient is physically moving locations, this order generates a bed request for the Admission & Transfer Center (ATC) to find a bed for the patient.
• ICU Expected Transfer Out Date - (Handout) The ICU expected transfer out date displays the date the patient is expected to transfer out of the ICU. This is intended only for bed/capacity planning purposes to assist with understanding our daily ICU bed capacity.
• Psychiatry Transfers to Periop Areas - (Handout) The process for psychiatry inpatients who need OpTime procedures in perioperative areas is covered.
• Requesting Transport for a Patient - (Handout) The Patient Transport activity is used to alert transport staff that assistance is needed to move a patient.
• Requesting Transport for a Visitor - (Handout) The Service Task activity is used to alert Guest Services Transport staff that assistance is needed to escort a visitor.
• Update a Patient's Location - (Handout) A patient's location is updated in order to keep track of the patient's movement within the hospital.
• Viewing OR Patients’ Destination Unit/Room/Bed - (Handout) Patient belongings are sometimes left in perioperative areas as patients are moved through surgery prep, procedure, and recovery. In order to easily return those belongings, transport staff must be able to quickly find the destination location for patients (those that will stay at UIHC for recovery). The Status Board activity is best for finding this information quickly.

Discharge

• Discharge a Patient - (Handout) When a patient’s discharge has been ordered, and the provider has performed Order Reconciliation, an After Visit Summary is typically printed, instructions provided by nursing staff, and the patient is released from the unit. At that time Unit Clerks and Nurses can discharge the patient through the Unit Manager activity.
• Discharging a Deceased Patient - (Handout) A deceased patient will be discharged from the Unit Manager with the discharge disposition of Deceased and will include the declared date and time of death.
• Organ Donor Process - (Handout) The unit clerk or nurse from the ICU or the OR will call the ATC when they have a patient who has deceased on the unit or in the OR and is a confirmed organ donor. The ATC will follow the Organ Donor Day Book documentation process in addition to the Epic documentation workflow below.
• Discharge Milestones & Delays- (Handout) Discharge Milestones are key activities or tasks that must be completed prior to discharge. Discharge Delays identify reasons patients are not discharged by 1100 on the day of discharge.
• Discharge Now vs Discharge Pending - (Handout) This document is a guide to utilizing the Discharge Patient order (ADT8) and new required question to capture specific criteria for a patient to meet prior to discharge or when all tasks are complete, and the patient can discharge immediately.
• Expected Discharge Date - (Handout) The Expected Discharge Date (EDD) and Time in Epic has strong multidisciplinary value towards throughput workflows within the organization, to meet regulatory compliances, and overall efficient discharge processes.
• Undo a Discharge - (Handout) The Event Management activity is used to track events that have occurred during the patient’s encounter. The Cancel Last Event button can be used to undo a discharge entered in error.
• Undo a Discharge – Disposition “Deceased” - (Handout ) Using Event Management to undo a discharge with a disposition of “Deceased”.
• Undo a Patient Status Marked “Deceased” via Registration Activity - (Handout) If a patient has been incorrectly marked as “Deceased” through the Registration activity, then the Registration activity should be used to undo this process. Marking a patient as “Deceased” cancels all future appointments, procedures, and admissions for the patient. This process to Undo will not reinstate those encounters. However, if the error is corrected within two hours, the inpatient orders will be reactivated.

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