Admission Discharge Transition Unit
The Admission Discharge Transition Center (ADTU) is an 18 room medical/surgical transitory unit for the adult and pediatric patients (age 16 and above with parent or guardian). The unit consists of 18 private rooms. 13 rooms (with pull curtains) can accommodate a bed with 5 rooms (with doors) accommodating standard hospital furniture for those admission/discharge patients that do not need to lie on a bed. However, the 5 rooms with doors can accommodate the hospital stretcher.
The unit does not have isolation rooms. Monitoring capabilities include bedside pulse oximetry (not centrally based) and remote cardiac telemetry monitoring from Unit 54. The unit does have wall-mounted oxygen and vacuum. The ADTU is open Monday through Friday from 0700 to 2300 except during those times when the Nursing Coordinator deems it necessary to keep the unit open through the hours of 2300 to 0700 due to an overall increased hospital population that places a hardship on available med/surgical beds within the hospital.
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Description of Patient Populations
Patients are admitted to Unit 52 from the Emergency Department, by direct admission, by referral via the consult team from other hospital units, and by hospital-to-hospital referrals and transfers. The care focus of the inpatient unit is treatment of individuals with psychiatric diagnoses and requiring electroconvulsive therapy and/or unstable medical or surgical problems or persons requiring neuro-psychiatric evaluation. Diagnoses most commonly treated include mood disorders such as major depression and bipolar disorder, dementia with psychosis or behavioral problems, schizophrenia, psychosis NOS.
Concurrent medical -surgical problems including delirium, post suicide attempts such as gunshot wounds, hanging, overdoses, sharp object trauma, motor vehicle crashes, burns; infectious diseases, unstable diabetes, renal failure, respiratory problems, epilepsy, Parkinson’s Disease.
Individuals treated in the ECT Procedure area typically have a mood disorder including depression, schizoaffective disorder, bipolar disorder. These individuals may be inpatients on Unit 52, inpatients at Shands at Vista which is a distinct part of Shands at UF, or they may be outpatients. These patients are usually adults. Adolescents may be treated with additional psychiatric consultation required as per the ECT policy.
Nursing Care
The primary mission of the ADTU is to see that the confirmed discharged Med/Surg/Peds patient is timely brought to the ADTU either by ADTU staff, a Med/Surg. Unit’s staff or in-house transport, then methodically and appropriately discharged from Shands Healthcare. Nursing care in the ADTU regarding the admitted patient is primarily focused on completing the initial assessment while performing a focused assessment. During this time all STAT or NOW orders are taken off and completed. A peripheral I.V. catheter will be placed when a physician’s order indicates so or is indicated by NOW or STAT orders.
If the patient has maintained a presence in the ADTU for two hours, unit staff will take off floor orders (providing the orders are on the unit), write the MAR, and begin giving medications/treatments/procedures as ordered for the home unit but as deemed appropriate for the ADTU. 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.
Healthcare team
The ADTU’s admitted and discharged patients are visited in the ADTU by their respective surgical/medical services consisting of Attending physicians, fellows/chief residents, residents/interns physician assistants, ARNP’s and medical students. Patient Care Resource Managers 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.
The nursing management structure consists of a Nurse Manager and Unit Assistant with support from a central Administrative Coordinator. Department of Nursing staff is provided training experiences to attain and maintain competence s defined by the unit/role specific job descriptions and the departmental education plan. Registered Nurses, Licensed Practical Nurses and Patient Care Assistants provide nursing care. Unit Clerks provide clerical support for the direct patient caregivers. The Registered Nurse is responsible for guiding care of the patient based upon an individualized plan. Nursing care delivered by LPNs and PCAs is coordinated under the direction of the Registered Nurse. Patient care is provided from Monday through Friday, 0700 to 2300.