The Admission Discharge Transition Unit (ADTU) is a 25-bed medical/surgical unit for adults. All rooms are private. Monitoring capabilities on the unit include bedside pulse oximetry (not centrally based) and remote cardiac telemetry monitoring from Unit 64. The unit is equipped with wall-mounted oxygen and vacuum but not medical air. There are no negative air flow rooms. The Hospitalist service is the majority service on the unit with an average daily census of about 21 patients, Occupancy rate on the unit is about 90 to 95%.
Description of Patient Populations
Patients can be admitted from the Emergency Department as well as those transferred from a nursing home or rehabilitation facility. ADTU patients can present as ambulatory, non-ambulatory, infected, and immuno-compromised.
Any patient requiring a reverse isolation room (negative airflow room), active diarrhea, a vasoactive drip, and inmates without Correction Officers are ineligible for the unit.
The primary mission of the ADTU is to provide safe, effective and quality nursing care while proactively facilitating the hospital’s patient throughput needs. Nursing care in the ADTU includes a focused assessment and implementation of the nursing process.
Nursing activities consists of: pain management including patient controlled analgesia, wound management, respiratory management including pulse oximetry, nutritional management including TPN, NG-tube/J-tube feedings, assessment and management of abdominal/GI drainage systems including G-tubes, J-tubes, ostomies, NGs, GU drainage systems, medication management, safety precautions and patient/family education and support.
Health Care Team
The ADTU’s management structure consists of a Nurse Manager, Clinical Leader, and Unit Assistant. The Nurse Manager reports to an Associate Vice President of Nursing.
The ADTU’s admitted and discharged patients are visited by their respective surgical/medical services consisting of attending physicians, fellows/chief residents, resident/intern physician assistants, ARNP’s and medical students. Social Workers and Case Managers serve as liaisons between the surgery/medical staff and multidisciplinary team providing continuity of care for the ADTU patient population from admission through clinic follow-up. Available support services for the ADTU patient include; Pharmacy, Respiratory Therapy, Physical Therapy, Occupational Therapy, Nutrition Services, Diabetic Education, Lift Team as well as Patient and Family services.
Department of Nursing staff is provided training experiences to attain and maintain competencies as defined by the unit/role specific job descriptions and unit orientation. Registered Nurses and Patient Care Assistants provide nursing care. The Support Tech role provides ambulatory support for patients and work with both the RN and PCA direct patient caregivers. The Registered Nurse is responsible for guiding care of the patient based upon an individualized plan. Nursing care delivered by PCAs is coordinated under the direction of the Registered Nurse.
Nursing care on the ADTU is based on the total patient care nursing delivery model (as described in the Hospital Plan for Nursing Care) with coworker assistance. The patient care assistant (PCA) is assigned under the direct supervision of a Registered Nurse. Skill mix is 70% RN, 30% PCA. The predominant staffing ratio of nurses to patients is 1:4-5 The ADTU CNs frequently takes patient assignments as needed. Patient care assignments are made each shift by the CN as described in the Hospital Plan for Nursing Care. Patient bed assignments are made by the CN and are based upon patient safety concerns, acuity, infection control restrictions, monitoring capabilities, and medical diagnosis. Patients requiring 1:1 observation as a result of personal safety concerns are assigned observational monitors. Requests for observational monitors are coordinated through the Central Staffing Office.
The staffing plan is fixed and based on an FTE budget of 27 RNs,12 PCAs, 4 Support Techs and 1 Unit Assistant. The ADTU is open 7 days a week, 24 hours a day.
In the event of an emergency such as severe weather conditions or other disaster, the minimum amount of staff required to safely operate up to 75% capacity would be 4 Registered Nurses, 2 PCA’s and 1Support Tech.
Reviewed and Updated 2/1/2021