## 9-HOSP/Transfer Pager Published 2/12/2026 On this page: - 9-HOSP Overview - Direct Admissions - Post-Procedure - HD Initiation - SICU/Non-MICU Stepdowns - Outside Hospital Transfers - Additional Notes **Who Covers 9-HOSP?** - 8a-5p – East Admitter - 5p-2a – Late (5p-2a) Admitter - 2a-6:30a – 12R Nocturnist - 6:30a-8a – East Early Rounder **Other Helpful Pages** - [Direct Care Admitting](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/ED,-Admitter,-and-MedEd-\(formerly-Merit\)-Shifts.aspx?csf=1&web=1&e=lgka0g) - [Geography Preferences - East vs West](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/Geography-Preferences.aspx?csf=1&web=1&e=Ts21rt) - [BIDMC Service Names](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/BIDMC-Service-Names.aspx?csf=1&web=1&e=SXiadv) - [Internal Transfer/Consult Workflow](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/Transfer-Consult-Workflow-Tool.aspx?csf=1&web=1&e=ET50un) **Overview** 9-HOSP (p94677) is the pager for transfer requests/direct admissions to HMED from: - Outside hospitals (including BILH hospitals) via the BIDMC Transfer Center - BIDMC non-medical ICUs - BIDMC procedure services - Interventional Radiology - Interventional Pulmonology - Advanced Endoscopy (ERCP) - Nephrology HD initiation **9-HOSP does NOT review transfer requests from BIDMC specialty services to HMED (ie surgery, neurology, oncology [OMED], cardiology [CMED], etc) or stepdowns from medical ICUs.** - If the patient is on East Campus, Klarman, CC6, Farr 7, Farr 8, or Farr 11 the HMED admitting team for that floor/campus will review. - If the patient is on a Farr resident floor, Deaconess 4, or CC7, the consult resident/attending will review. - If the patient is in the ER, the patient will be added to the Admission Tracker ER list to determine whether HMED or MED ED will review. - If the patient is in a medical ICU and is assigned a floor bed, the appropriate geographic admitting team for the floor bed will review. 9-HOSP is often paged by other services when they are not sure how to get in touch with the correct HMED team/attending. Please try to help them find the right person – the system can be confusing!  If you have questions about 9-HOSP, feel free to ask/discuss with any fellow hospitalists who have done the role before. Covering 9-HOSP can be a complicated and nuanced role and there are often questions! See [Internal Transfer/Consult Workflow](https://bilh.sharepoint.com/:u:/r/sites/HospitalMedicine/SitePages/Transfer-Consult-Workflow-Tool.aspx?csf=1&web=1&e=CyS4cg) for more information. **Direct Admissions** Direct admissions are admissions directly to the floor without evaluation in the ER. These cases typically fall into the below categories. - Post-procedure admission for a patient who presented for a planned procedure in a procedure unit within the hospital with IR, IP, or ERCP or for planned HD initiation with Nephrology and requires admission for standard post-procedure monitoring/management. This is the most common type of direct admission request. - Occasionally, there are requests for unplanned post-procedure admission (ie, complication, new problem peri-procedure) that must be reviewed for appropriateness for the floor. - The procedure team will reach out to 9HOSP at some point before/during/after the procedure on the day of the procedure to discuss admission. If the procedure is not complete yet, okay to conditionally accept so that the bed facilitators can look for a bed, and ask the procedure team to check in post-procedure to ensure continued acceptability for direct admission to the floor. - For all cases, 9-HOSP should review the appropriateness of the case for direct admission to the floor. - If the patient is appropriate for direct admission to the floor, refer to the workflow below. - If the patient requires further triage or stabilization before admission to the floor, communicate this assessment to the primary procedure team to allow them to coordinate further. If triage/stabilization in the PACU is unable to be performed with the primary team, the primary team can refer the patient to the ER or ICU as appropriate. - Inpatient colonoscopy preps, ie, a patient who presents from the community for a planned admission for inpatient colonoscopy prep and subsequent inpatient colonscopy. If you receive a message about a patient in this situation, review the patient's chart for notes re: the planned admission. The admission request will have been reviewed by hospital medicine (Dr. Marisa Jupiter reviews these). Search for a note from Deanna Emma (admin in GI) with Marisa's name in the note outlining the case. You may have to look back several months as sometimes the colonoscopies are planned well in advance.  If there is no such note, email Marisa about the case. You do not necessarily have to reach out to the GI fellow on admission, but can if you would like. - Direct admission requests from clinicians for patients from the community/outpatient healthcare settings that do not fall into the above categories can be arranged occasionally, depending on:  1. **Clinical appropriateness for admission to Medicine and not requiring more urgent, emergent, or timely evaluation and management in the Emergency Department first**. If the clinical circumstances warrant immediate assessment, stabilization, and triage, then the patient should be referred to the Emergency Department. 2. **Bed availability.** If the patient is clinically stable enough and appropriate for admission to Medicine, then a bed request for admission for the patient can be requested of Admitting/Bed Management. Admissions coordinators will need to then communicate with the patient and/or referring MD to advise the patient on where to report.  Sometimes this can take some time, so this delay will need to be taken into consideration with the clinical context in determining the most appropriate path for the patient (ie, going to the ED vs waiting in clinic or at home for available bed, etc). If the patient cannot be safely monitored or safely wait for any possible delay, they may need to present to the ED.  - If you are accepting a patient in this situation, a note should be entered in Epic outlining the request, circumstances, accepting MD, and plan (akin to what we enter for post procedural and OSH transfer admission requests), and an email sent to our group.  If you are covering 9HOSP, receive a request for direct admission, and have any questions not answered above or by colleagues, please contact the Hospitalist Leader On Call (HAOC) at pager #94262. For post-procedure admits (IR, IP, ERCP, Nephrology HD initiation) 1. While in the PACU, the procedure team will admit the patient to their service. IP admits to “Pulmonology” and ERCP admits to “GI” under their respective subspeciality attendings, not hospitalists.  They have a post-procedure order set that includes this order. If they are stuck, they can place an ADT-16 order.  Here is an example for IR, which is found in the “Post-procedure Navigator” as part of the IR Post-procedure order set. (IP may need to use the “post-bronchoscopy” order set.):  ![](blob:https://bilh.sharepoint.com/17452383-8a6b-4fcd-919f-4277524409fa) 2. The procedure team will place a sign-out note in Epic. (We are no longer using email signouts.) They will then page or Secure Chat 9-HOSP to review. 3. After receiving the page/Secure Chat, review the sign-out note and other documentation. Discuss with the procedure team as needed.  4. If no discussion is needed or once you agree with admission, place an ADT-7 order to accept the patient to medicine (see below). This will allow the bed placement team to start to look for a bed.  You do not need to send an email or write an additional note in the chart. The residents and admissions facilitators will look for the ADT-7 order.  You may need to release this order if it is “Signed and Held.” ![](blob:https://bilh.sharepoint.com/3cde4028-2b79-4291-be55-b35caa4a3f84) 5. Add the patient to the admission list for situational awareness (ex ERCP patients coming east). Have 2 ways to do this: - Find the patient in the “Preadmitted Patients” list. Right click, select “Assign Teams." Add BIDMC Gen Med Admissions team (if patient is on West campus or you are unsure) or BIDMC HMED East Admissions team (if likely to be assigned an East campus bed, ex post-ERCP).   ![](blob:https://bilh.sharepoint.com/79d24ced-c36e-4bda-993f-8289f210af85) - Look up the patient through “Patient Lookup” using their MRN. Click on “Encounters," find the procedure encounter (this may be called an admission encounter or a procedure encounter depending on whether admitting has created an inpatient encounter yet.) Click on the stethoscope which gets you into the specific encounter. Click the “Attending” or “First Contact” in the left-hand column to open the “Treatment Team." Add the appropriate admission team under “Add Provider Team.” ![](blob:https://bilh.sharepoint.com/6a6ea025-a710-4ec0-83cf-47f0383d2168) ![](blob:https://bilh.sharepoint.com/19eeebc1-9591-4523-b56a-e55aff8b1d92) Now you can find the current team on the left-hand column and click on it ![](blob:https://bilh.sharepoint.com/e4912efd-b596-41a5-a4d0-8abaeb21e180) 6. When the patient gets a bed, the appropriate medicine admitting team takes over (based on geography). They will get sign-out if needed and place a "Ready to Transfer” order to allow the patient to move from the PACU to the floor.  7. The admitting team does the admission. --- HD Initiation Specific Workflow ![](blob:https://bilh.sharepoint.com/72d6e56d-1e85-49a3-9053-8c8fec871266) - Post-HD initiation admits generally follow a similar workflow as the post-procedure direct (IR, ERCP) admit pathway. - The patient is located in dialysis unit on Farr 7 instead of PACU. - The morning of the admission, the nephrology team will send out an email reminder with patient information. - Once the patient arrives in the HD suite and HD is initiated, the Nephrology fellow will reach out to 9-HOSP (via secure chat/ pager or both) for admission request. - Once you receive the request, review the patient, reach out to the fellow if needed, and if appropriate for floor, place ADT 7 order (transfer of service). This will alert the bed office to start a bed search. Once the patient has a bed, will be admitted by the geography specific team.  *IP Provider = 9-HOSP **COMMON DIRECT ADMISSION ISSUES AND PITFALLS** 1. The procedure team cannot find the post-op order set.   - Ask the procedure team to place an ADT-1 or ADT-16 (Initiate Extended Recovery), even without the order set.  2. The procedure team cannot find their team to admit to.   - ERCP admits to “GI” and IP admits to “Pulmonology.” They should NOT admit to Hospital Medicine. Only HMED and the ED team can make that request. 3. I can't place an ADT 7 order or I have tried to add the team to the admissions list, but I cannot see them. There’s an extra step that the admitting office has to do to make the patient an inpatient. If the patient is not showing up, this may have not been done yet. You can call the admitting office and ask them to click the "Admit to IP button from Patient Station" (“turn the admission red”).  4. I am being asked to send an email.  You do not need to send an email. Your ADT-7 order designated that you have accepted this patient to medicine. The residents and bed facilitators have both been told this.  But it does not hurt anything if you want to send one. 5. Something just is not working right! That’s okay – we know there are some issues we are trying to work out! Right now, it can be difficult to tell what is a system-error or user-error. Please encourage the team having trouble to submit a ticket in Epic in case it is the former and feel free to reach out for help if needed!   **SICU/Non-MICU Stepdowns**  Similar process to above. 1. The ICU team will place a sign-out note in Epic. They will then page or Secure Chat 9-HOSP to review. 2. After receiving the page or Secure Chat, review the sign-out note and other documentation. Discuss with the ICU team as needed.  3. If no discussion is needed or once you agree with admission, place an ADT-7 order to accept the patient to medicine (see above). This will allow the bed placement team to start to look for a bed.  You do not need to send an email or write an additional note in the chart. The residents and admissions facilitators will look for the ADT-7 order.  You may need to release this order if it is “Signed and Held.” 4. When the patient has a bed, the assigned admitting team will place the "Ready to Transfer” order to allow them to be transferred to the floor. **Outside Hospital Transfers** 1. 9-HOSP will receive a page from an admissions facilitator (AF) working in the Transfer Center regarding the request. The page will include an MRN if available. 2. Review the patient if there is an MRN and return the call to the AF. The AF may have more information about the case. 1. If the transfer is related to the need for a consulting team or procedure (ex ERCP), the AF may have already talked to the specialty team. If they have not, can ask the AF to do so now if appropriate. If more information about the case is needed, talk to the outside provider, then you or the AF can reach out to the specialty team. 2. The specialty team may have a different assessment re: the need for procedure or offer an alternative, such as a round-trip or outpatient follow up.  3. If you are ready to hear the case, the AF will initiate a 3-way call with the OSH provider requesting transfer. 4. After listening to the case, you can decide to accept, defer, or decline the transfer. If you are not sure, you can say so and let the outside provider and AF know that you would like to discuss the case with a colleague. Review the case with another HMED attending or Lish Clark and call the AF/outside provider back with your decision. 5. Write a note in Epic and send an email. 1. Epic 1. Accepted - 9-HOSP template is (“.HMEDTRANSFER”) 2. Declined or Deferred - Use the same template and change as needed. 2. Email 1. Send to HMED signout and Nurse Admission Facilitators 2. Include your decision, MRN, and reference to the note in Epic. **All outside hospital transfer requests to HMED should come through this pathway. If you are paged directly by a provider at a different hospital, please re-direct them to this pathway. The AFs can help provide context about capacity and realistic timing for a transfer patient to be brought in.** *Note: To streamline admissions, transferring hospitalists from BIDMC community sites should please use the “Discharge to Readmit” tab within the Discharge tab so that orders can be continued on transfer. If you are 9-HOSP, please remind the transferring hospitalist of this workflow during the call. ![.](blob:https://bilh.sharepoint.com/4f812dfd-91cf-4e24-8c9f-9137bcbecb6c) **Additional Notes** None currently! ## The Triage Role Published 1/27/2026 Since we work so closely with the residents on the MED ED rotation in this role, [here is the link](https://bilh-my.sharepoint.com/:p:/g/personal/ademarsi_bidmc_harvard_edu/ESsp48ZstBZMsHkc2DzxGE0BFN1cMKlOgc1tZumBdR-tCw) to the residency’s MED ED living document, which includes the most updated information of hours, expectations, and process maps for the residency MED ED Teams. Of note, this document includes HMED workflows as well as all other team workflows that do not apply to HMED. Hopefully, having this situational awareness of the other roles/responsibilities of the residents will help improve our teamwork. _For the purposes of admissions:_ _HMED = Direct Care_ _MEDED = Teaching Service/Resident Teams_ **How to Triage:** - The person assigned to the Triage Role will be signed into the BIDMC Gen Med Admission List as the **Covering Provider**. - When a new General Medicine request is placed by the ED, you will get an automatic Secure Chat message with the patient's information.  - You DO NOT need to open the chart to determine if the patient is appropriate for admission or if a specific campus is preferable. This will be the responsibility of the assigned team. However, if you have some time to do so, briefly reviewing the case can expediate the process if you identify a specific campus preference. - If the residents are assigned a patient who they believe should go to East Campus, they should run it by the Med ED attending, who can reassign to direct care as needed. - The residents are being asked to review cases with the Med ED attending in which there is a question about floor appropriateness that requires an attending-to-attending discussion.  - Refer to the Admission Tracker to see which team (i.e. HMED vs MED ED) is up next for an admission.  - Add the appropriate team to the chat via the “Add participants or Groups” button.  - If HMED, add “BIDMC HMED West Admissions.”  - If residents, add “BIDMC MED ED.” - Once the evaluating team is added, message the team in this group chat with “New admission request, [team] please review.” - Make sure the appropriate service is selected for the bed request (ADT-9 order) placed by the ER. This is located under the “Orders” tab, all the way at the bottom. - For patients assigned to HMED, the ADT-9 service should be “Hospital Medicine.” This is the default when the ER places the order. - For patients assigned to MED ED, **edit the ADT-9 order to change the service to “Internal Medicine – Teaching.” Please do this as soon as MED ED is assigned to review to help prevent mis-assignment of beds.** - Add the patient/MRN to the Admission Tracker. If it is a Med ED patient, add your name (or the next Med ED attending if appropriate) to the Admitter/staffer column. If it is a HMED patient, the admitters will distribute amongst themselves. - Once the patient is accepted and the primary team has been changed appropriately, remove the patient from the “BIDMC General Medicine Admissions” List. - Right-click on the patient, select “Treatment Team," ensure the patient’s Primary Team is correct, then click “Remove” next to “BIDMC General Medicine Admissions." - The admitters may do this, but you can as well. **Tips/Special Circumstances:**  - If a team is ultimately not admitting the patient to medicine, remove them from the Admission Tracker. Add the next patient in their place. - In the Triage Role, you do NOT need to assign admissions to individual providers. MED ED and HMED will decide amongst themselves who will be doing the evaluation/admission. - If a patient assigned/admitted by HMED or MED ED gets a bed not in their geography, note this is in the Admission Tracker under “Bed off geography?” - If a patient assigned/admitted by MED ED gets a bed on an HMED (i.e. non-Farr) floor, do NOT call the bed facilitator to change the bed unless it is required for clinical care (ex: assigned East but needs West for proximity to cardiology).  - If a patient assigned/admitted by HMED gets a bed on Farr, add them to the BIDMC Farr Gen Med Admissions List and write in the “My specialty sticky note”: “HMED -> Gen Med (Farr)." Make note of this in the Admission Tracker as well so the night MED ED attending can use it as a reference when running the list with the Night FLEX resident at the end of the night. You can add this to your columns for easy access (see picture). ![](blob:https://bilh.sharepoint.com/c5b22474-9e69-45da-ad75-03cb6c877449) ![](blob:https://bilh.sharepoint.com/aaa3b444-b91a-4a67-b28f-ff380bc88681) ![](blob:https://bilh.sharepoint.com/3fde8702-8602-490b-9437-1cfe07cb9000) ![](blob:https://bilh.sharepoint.com/193761cd-4f75-4d75-9845-24e353cfe12a) ## Medicine Consults Published 5/4/2025 On this page: - Overview - Workflow - West Campus - East Campus **Overview** - Hospital medicine does medicine consults on East and West Campuses, each with separate consult teams and consult orders. The campus designation in the order will automatically put the patient on the appropriate campus consult list. - Inpatient consult to Medicine (WEST) order → BIDMC Medicine West Consults List - Managed by the consult resident and attending (or overnight resident admitters and Night Med ED at night) - Inpatient consult to Medicine (EAST) order → BIDMC Medicine East Consults List - Managed by the East Admitter (or Late (5p-2a) Admitter and East Nocturnists at night) - For a routine medicine consult, the patient will automatically be added to the respective consult list when the order is placed and a Secure Chat will be sent to the Covering Providers. A page will NOT be sent. - For a stat consult, the patient will automatically be added to the respective consult list, a Secure Chat will be sent to the Covering Providers, and a page will be sent. **Make sure you are signed into the appropriate lists and pagers to ensure you receive messages in a timely manner.** **Workflows** **West Campus:** - Managed by consult resident and attending during the day, overnight admitting residents and Night MED ED overnight. - The consult resident is also known as the CAT (Consults and Transfer) resident. - The consult resident will sign into the BIDMC Medicine West Consults List and pager (p96322) - The consult attending can also sign into the BIDMC Medicine West Consults List as a Covering Provider, if you would like. If not, be sure to touch base with the consult resident to make sure you are up to date on the consults. Sign into the West Consult attending pager (p99378). - The consult resident will triage, see the consult, and staff all medicine consults on West Campus, regardless of location (ie, KM, Rosenberg, Farr). - The consult resident and attending also review transfer requests from BIDMC specialty services (ie surgery, neurology, etc) if the patient is in the Farr building, Deaconess 4, or CC7. - Medicine does not perform consults on BIDMC Geriatrics primary patients. - If an urgent consult is needed overnight, the overnight resident team and Night Med ED will do the consult. **East Campus:** - Managed by the East Admitter during the day, Late (5p-2a) Admitter and East Nocturnists overnight. - Sign into the BIDMC Medicine East Consults List as the Consulting Provider and the East Direct Admissions and East Consult pager (p34677). - See new and follow-up consults during the day. Sign off consult when appropriate. - Sign out List and pager to the Late (5p-2a) Admitter. 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