Writing Admission and Transition Orders

Revised and Approved by the ACEP Board of Directors October 1993; and Revised titled, "Writing Admission and Transition Orders" April 2010
Reaffirmed by the ACEP Board of Directors October 1992, 1997, and 2001
Originally Approved by the ACEP Board of Directors October 1989

As an adjunct to this policy statement, ACEP's Medical Legal Committee has prepared a Policy Resource and Education Paper (PREP) entitled, "Writing Admission and Transition Orders"

The American College of Emergency Physicians (ACEP) believes that the best patient care occurs when there is no ambiguity as to who is the physician responsible for the patient. Medical orders establish which physician is in charge of a patient's care. Emergency physicians generally do not have admitting privileges and do not provide continuing inpatient care.

Therefore, ACEP endorses the following principles:

  • Patients are best served when there is a clear delineation of patient care responsibility.
  • The emergency physician is responsible for care of the patient only while the patient is physically present in the emergency department under their care.
  • The admitting physician is responsible for care of the patient after they have accepted responsibility for the patient’s admission, regardless of the patient’s physical location within the hospital.
  • When an emergency physician is compelled to write orders that appear to extend control and responsibility for the patient beyond treatment in the emergency department to the inpatient setting, it is understood that the admitting physician retains responsibility for providing inpatient care.
    • However, in the interest of patient care and safety, an emergency physician may be compelled to write transition orders.
      • These transition orders may include essential treatment and assessment parameters required before preparation of suitable admission orders.
  • Hospital and emergency department policies should clearly delineate responsibility for writing admission or transition orders. Policies must define an appropriate period of time for the admitting physician to see the patient and prepare admission orders.
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