Children’s Hospital Patient Placement Guidelines
In-patient units August, 2011
In order to ensure bed availability in the Children’s Hospital, provide an atmosphere that is
appropriate for children and to match nursing skills and service to the population served, the
following guidelines have been developed by the Children’s Hospital Leadership group.
1. Patients over the age of 17 will not be admitted to a CH unless an online exception form
is done by the physician admitting the patient (possibly link):
a. Young adults with developmental delays 18 years and older should be admitted to the
b. Young adults with oncology diagnosis receiving chemotherapy will be admitted to the
c. Pediatric cardiology patients: Adults up to the age 25; ages 25 – 60 with identified
criteria. Adults 60 years and older will be admitted to the adult hospital.
2. Exception to the above may be made with the approval of the following through the
online exception form:
- Children’s Hospital Administrator or designee
- MUSC Medical Director or designee
Each decision will be made on a case-by-case basis taking into consideration patient
disease status, medical needs, nursing competencies and current census.
4. The bed assignment will be made based on the child’s needs and diagnosis. Information
used to determine the most appropriate placement will include diagnosis, isolation status,
intensity level, staffing requirement, pre-existing conditions, and census (current and
Unit Primary Populations Size of Unit Ages
7E General Medical/Surgical 25 Operational Beds 5 years - 17years
Video EEG Corrected age must be
Burn > 30 days
Trauma Crunch (no bed available):
CF with diabetes >30 days
< 4 years
7A General Medical/Surgical 18 Operational Beds 4 years old and under
Neurology/Neurosurgery Maximum census = 22 Priority unit for <1yr
Up to age 8 years old
7B Hematology/Oncology 18 Operational Beds All Ages
Endocrine Maximum census = 18 Adult oncology pts
Solid Organ Transplant 12 – regular
Bone Marrow Transplant 6 – BMT positive pressure
8D Cardiology 10 Operational Beds Newborn – 25 years
CT Surgery Maximum census = 10 25 yrs – 60 yrs criteria
Heart Transplant >60 yrs adult hospital
PICU Pediatric Intensive Care 11 Operational Beds Up to age 17 years
Intermediate Care Peds Ortho >17 years
Intermediate Ventilator Dependent 10 Operational Beds All Ages
Care (7C) Intermediate Care Patients
Have monitored beds
PCICU Cardiac Intensive Care 10 Operational Beds Newborn – 25 years
Intermediate Cardiac Maximum census = 12 25 yrs – 60 yrs criteria
>60 yrs adult hospital
ED Patients requiring < 24 hour 12 Operational Beds Up to age 17 years
Same Day Pre-op cardiac surgery 6 Operational Beds All ages
(Open until Pre heart catheterization
1900) Post GA/sedation heart cath
Procedure GI procedures 5 Operational Rooms Up to age 17 years
Area Urology procedures 10 Recovery Bays
(Open until Sedation
Bed Placement Guidelines
Diagnosis 7E 7B 8D 7A
Adenovirus AL No No AL
*Droplet/Mask if resp s/s
Aplastic Anemia HI US HI HI
Asthma US HI HI US
Burns AL No No No
Cardiology, as approp. HI HI AL HI
C-Diff *Contact AL Subsp CV AL
Continuous Nebs AL AL AL AL
Cystic Fibrosis AL No No AL
CT Surgery, as approp. HI HI AL HI
Diabetic with CF AL No No AL
Diabetic/endocrine HI AL CV service HI
*new dx on 7B
EVD/Lumbar drain AL No No AL
Fever, R/O Sepsis AL Subsp + HI CV +HI AL
Flu AL Subsp pts. CV AL
*Droplet if over 6yr
*Contact/Droplet under 6yr
GI US HI HI US
ITP HI AL HI HI
Hemophilia HI AL HI HI
Insulin Pumps No AL No No
Kawasaki AL HI HI AL
Lupus HI AL HI HI
Meningitis US HI HI US
MRSA AL Subsp + HI CV +HI AL
Neurology US HI HI US
Non-infectious Surgical AL HI HI AL
Oncology Non Chemo HI w/ varicella AL No HI w/ varicella
Oncology receiving Chemo NO AL No No
Orthopedic AL HI HI AL
**Parvo *Droplet AL No No AL
Peritoneal Dialysis No AL No No
Pertussis *Droplet/Mask AL No No AL
Pulmonary AL HI HI AL
Renal HI AL HI HI
Rooming In No No HI AL
RSV *Contact/Mask AL No CV Service AL
Sickle Cell Disease HI AL HI HI
TB AL No No AL
Transplant HI AL BMT/kidney/ liver AL - heart HI
Wound Vac US HI HI US
Video EEG AL No No HI
Urology AL HI HI AL
Varicella AL No No AL
Bed Placement Codes:
AL: Always, must go on this unit
US: Usually, priority placement if bed is available
HI: High Intensity No bed immediately available and/or extenuating circumstances on other unit
No: Cannot be placed on this unit
Bed Placement Infusion Database (Intranet/Staff toolbox):
Guideline to identify which units continuous infusions can be done on (Link site)
Patients on continuous nebs - See guidelines
BIPAP pts will be discussed on a case by case basis for established pts on bipap
Ventilator dependent patients are admitted to the ICUs and Intermediate Care Unit
*Patients being tested for Parvo as part of a general transplant/rejection screening
evaluation who remain asymptomatic and the MD has a low index of suspicion may
remain on 7B.
Patients will not be diverted to units based on number of admissions assigned to unit.
Patients will remain on 7C if possible until discharge or will be transferred based on unit
needs as directed by charge nurse and MD.
Negative Pressure Rooms Chickenpox TB
If no rooms available,
contact infection control
practitioner on call.
7006 – 7E 7006 – 7E
7007 – 7E 7007 – 7E
7011 – 7E 7011 – 7E
7012 -7E 7012 – 7E
713 – 7A 727 – 7A
727 – 7A 734 – 7A
734 – 7A Bed #2 - PICU
Bed #2 – PICU
Video EEG Rooms 7E 7A
Should go to 7E first.
7013 706 – 711
7014 729 - 733
Vapotherm can be done in the non-ICU areas based on this criteria:
Respiratory will set up equipment
Infants less than 12 months should be on 2L nasal cannula or less; needs greater
than this will be evaluated on an individual basis
Infants over 12 months of age must have oxygen requirements of 4L or < nasal
If oxygen needs become greater, respiratory and the MD will need to evaluate
patient for Intermediate care unit or ICU
Crash Bed Guidelines:
1st Priority – PICU
PICU is full at 11 beds and PCICU has open beds; PCICU is the crash bed
PCICU is full at 12 beds, discussion with PACU about using them as crash bed
PACU may need to be the crash bed or negotiate transferring a patient out of PICIU
or PACU and then the PICU will become the crash bed. This could be a less acute
patient or a patient waiting on a non ICU bed. The PICU attending will triage to
determine if a less critical patient is more appropriate for transfer to the PICU.
The PICU manager, HSC, and bed management will coordinate this.
Staffing levels are not factored into the ability to have a crash bed. If staffing is tight
and a crash bed is needed, the open unit will take the critical patient. After the patient
is stable the unit needs will be assessed.
Guidelines for Admission of Obstetrical patients:
Previable <20 weeks - Can go anywhere as no intervention will be possible at this
gestational age to save pregnancy if miscarriage is threatened
Periviability, 20-23 weeks gestation - Notify OB service of periviable hospital admissions
and determine level of service OB should provide. Admission to OB floor is generally
recommended. There may be instances that care can be optimally provided on another
floor with OB as primary consultant. This would require formalized information from
OB nursing for peds to provide appropriate care
Viable >24 gestation - Admit to OB floor
Before getting a direct admission to the floor, you should receive report from the outlying
hospital, MD Office, or other facility. If this does not happen, please let your nurse manager
know this so this can be communicated to bed management.
Should be placed on 8D (May be in with other primary dx but have this also l isted):
Hypoplastic left heart syndrome
Hypoplastic right heart syndrome
Post Bidirectional Glenn
Pre-op Tetrology of Fallot due to TET spells
Can be place on other CH Units in the event a bed is not available on 8D:
ASD Repaired Tetrology of Fallot
VSD Truncus Arteriosus
Coarctation of aorta Pulmonary stenosis
Interrupted aortic arch
Transposition of the great arteries
Double outlet RV
GUIDELINES FOR ADDRESSING HIGH CENSUS EVENTS
1. Admissions to the Children’s Hospital inpatient areas will be coordinated through the
Admission Transfer Center.
2. If inpatient beds are not readily available, alternative options will be explored:
a. Assure discharges occur as early in the day as possible
b. Case Managers and Clinical Unit Leaders will evaluate potential discharges
c. Maximally use same day area for patients waiting to be discharged, for
procedures, and for short-stays, for example after ambulatory surgery.
d. Discharged patients (non-contagious) waiting for a ride may be discharged and
allowed to wait in the first floor lobby area accompanied by parent.
e. Adult discharged patients my wait in discharge lobby in the first floor lobby.
f. Same Day can be used to begin the admission process when discharges are
g. A temporary admission to PICU, PCICU, or Intermediate Care Unit coded as non
h. ED patients will be evaluated on boarding options based on staffing, severity of
illness and length of wait.
3. If ICU beds are not available, alternative options will be explored:
a. ICU MD and Clinical Unit Leader will evaluate who can safely be transferred to
an inpatient unit
b. Coordination with NM, bed control and/or house supervisor
GUIDELINES FOR ADDRESSING HIGH CRITICAL CENSUS EVENTS
ALL requests for pediatric patient placement will continue to flow through Admission Transfer
Center (ATC) in collaboration with the Nurse Manager, house supervisor and/or MD.
1. When the attending and/or charge nurse in the Children’s ED are concerned about the
ability of the ED to continue to treat patients due to the back-up of patients in the
rooms and hallway, they will contact the ED NM or house supervisor. The house
supervisor will contact the Nursing Director of the Children’s Hospital or her designee
to initiate the Overcapacity Plan.
2. The Director will notify the NM during the daytime, Administrator and coordinate bed
placement activities with the ATC and the House Services Coordinator (after hours).
The NM or HSC will coordinate these activities with the CUL or charge nurse.
3. If CH Overcapacity Plan is instituted, coordination will be done to expedite patients
from the ED as soon as they can safely be transferred. The unit will need to accept the
patient and a STAT transfer and report will be done. ATC will be notified.
4. The CH Overcapacity Plan will evaluate alternative locations for patients:
a. Semi-private room usage
7A has 4 semi-private rooms
8D has 4 semi-private rooms
Guidelines for patients that must be in a private room.
Patient with sustained fever of unknown origin. If patient has negative cultures or
antibiotics have been started, okay to pair.
Patient with infections requiring respiratory (airborne or droplet) isolation or contact
precautions, except patients with same organism (e.g., RSV, CMV) Consult Infection
Control as needed.
Patient colonized or infected with MRSA, or suspected of having community
acquired MRSA. Older children with soft tissue infections such as a skin abscess or
cellulitis that could be potentially be MRSA
Escalating social issues (this could be overridden if needed)
Neutropenic patient (ANC less than 1000)
Solid organ and Bone Marrow Transplant patients.
Patients on peritoneal dialysis
Terminally ill patient (this could be overridden if needed)
Patients with external ventricular devices.
Sickle Cell patients with crises thought to be caused by infection, such as Parvovirus
if known. Two febrile sickle cell patients can be put in a semi-private room, but a
febrile and non-febrile patient should not be put together
Patient with Cystic Fibrosis
Private room preferred but can safely be placed in semi-private room
Infants < 8 weeks old
Patients with RSV. Patients may be doubled with another RSV positive patient as
long as the symptoms are similar
Patients with an infection of the same causative organism; (except MRSA)
Patients with a large amount of equipment or anticipated long length of stay.
Patients < 4 years old with fever, RSV negative bronchiolitis, varicella,
Treatment Room evaluation:
Treatment room bed numbers as follows:
7A E721 8D E821 7C – Will not accommodate crib or bed
7B E762 7E 7017
The unit treatment room will be evaluated for admitting patients based on unit activity:
The appropriate bed or crib will be obtained (so the patient does not remain on a stretcher
any longer than necessary)
A comfortable chair will be obtained for the parent when possible
A manual bell will be obtained or call bell will be in treatment room
The treatment door will be wedged open at all times to assure a call for help can be heard
Curtains will be pulled around the patient for privacy
If available, an over bed table will be obtained
The patient’s admission will occur as if the child was in a bed (orders written, therapy
initiated, assessment documented etc)
Service Recovery: The patient/parent will receive an apology and explanation for the
placement, which we hope will be short term. They will be told that individuals will need to
enter the room for supplies from time to time.
Service Recovery: The patient/parent will receive a visit by the manager/HS and/or director
to apologize for the placement and ask for their tolerance.
The Designated CH NM, Nursing Director, HS, and/or MD will attempt to make walking rounds
to identify potential patients for discharge or transfer.
The Nursing Director, HSC, or Administrator will determine when further steps are warranted or
when step-down to normal operations is appropriate
High Census Adjustment to Admission Guidelines for Children’s Hospital
During periods of high census, the guidelines for Pediatric Critical High Census Events will be
instituted. In addition to the options listed in those guidelines, the following age-specific
admission changes will be instituted.
1. Patients age sixteen years (16) and above will be considered for admission to adult
units provided their admitting diagnosis is not restricted to a pediatric unit.
2. The ATC will assist in determining the availability of adult beds and appropriateness
of this option for pediatric patients ages 16 and above.
3. Patients will be placed on any unit, as defined by Bed Placement Guidelines, with bed
availability and will remain on this unit until discharge.