Request for Social Hold in Pediatrics

1. Request for Social Hold in Pediatrics Policy Updates TX-383 Pam Sanders, MSN, RNC-NIC, CENP Vice President , Women & Children’s Services

2. Purpose: • To provide guidance for addressing requests for the admission or hold of a pediatric patient who does not meet medical criteria for inpatient or observation level of care

3. General Statements: • TGH employees & members of the medical staff are not responsible for performing the Children’s Multidisciplinary Assessment Team (CMAT) evaluations. • This is the sole responsibility of the Florida Department of Children and Family (DCF) Services or its legally designated agency. • Any child brought to the ED will receive a medical screening evaluation. • If no emergency medical condition exists which requires further observation or hospitalization, the patient will be discharged.

4. Requests for Social hold or admission of a child who is currently not a patient in the hospital: Presents to the ED: Presents as a direct admit: TGH will not accept direct admit requests via the Transfer Center or via direct communication to an admitting MD Notify the Manager or Clinical Admin Supervisor & the NAOC If no medical condition exists which requires observation or hospitalization, the patient will not be accepted • Perform medical screening exam • Notify ED Manager or Clinical Admin Supervisor • Supervisor will notify NAOC and the Director of Case Management • If no emergency medical condition exists which requires further observation or hospitalization, the patient will be discharged

5. Requests for the Social Hold of a patient who is already an inpatient & now meets medical clearance for discharge: • If the Social Worker cannot place a patient in the custody of DCF with active discharge orders, immediately notify: • Manager of Social Work and/or Director of Case Management • Nurse Manager of the inpatient unit • Attending Physician • Vice President of Women & Children’s Services

6. Next Steps: • The Director of Case Management and/or Manager of Social Work will notify the legally designated agency for DCF and the Director of the Department of Children & Family Services to expedite placement. • The Director of Case Management will notify the Risk Management, AHCA and/or CMS of DCF’s inability to find placement

7. Daily Discussions: • Daily discussions will occur to discuss placement status until appropriate placement has been found. • Document all communications in the EMR. • Daily discussions will include (or designee): • Director of Case Management • Director of Risk Management • Legally designated agency for DCF • Inpatient unit NM • Vice President of WCS