Hospitalist Admission and Rounding Pocket Guide

Accepting every admit request without asking about home support, transportation, and who can check on the patient tonight.

Translating the complaint into a diagnosis before the history is done. A patient who says the room is spinning has not said vertigo.

Leaving VTE prophylaxis or the diet order to be added later. Later is often too late.

Reading only the physician cross-cover note. Nurses record the early signs that physicians miss.

Ignoring a patient who fails the screen but looks unwell. A screen supports your judgment but does not replace it.

Using the score on a patient with ST elevation or hemodynamic instability. It applies only to undifferentiated, stable chest pain.

Excluding pneumonia on an early normal film in a dehydrated patient with a strong clinical picture. Repeat the imaging if suspicion remains.

Fever with flank pain, an obstructing stone, or sepsis needs imaging and a different pathway.

Hypotension, hematemesis with altered mental status, or a falling hemoglobin despite transfusion needs the ICU, airway protection, and urgent endoscopy.

Hyperkalemia with ECG changes, refractory acidosis, volume overload, uremic symptoms, or toxic ingestion needs urgent nephrology review.

Using sliding scale insulin alone. It reacts to high values and does not prevent them.

A Glasgow Coma Scale of 8 or less, a blown pupil, or fever with neck stiffness needs immediate action.

Check baseline hemoglobin, platelets, creatinine, and weight. Recheck platelets on heparin.

Any neurologic deficit or airway symptom is time-critical.

Ordering an opioid alone, as needed, without scheduled non-opioid drugs.

Ordering a stress test or echocardiogram for a low-risk patient, which delays surgery without changing management.

Adding a drug for each new symptom without asking whether a drug caused it.

Asking 'please evaluate' without a question, or leaving an urgent consult in the electronic queue.

Equating capacity with a cognitive test score, a psychiatric diagnosis, or disagreement with your advice.

Discharging by the clock without checking the pending issues, such as an unsafe home or a missing prescription.

Choosing status by bed availability, payer, or the time of day instead of the clinical expectation.

Accepting the ED summary of the family's account without speaking to them. Details are lost at each handoff.

Ordering strict NPO after midnight for a procedure that may not happen. Prolonged NPO status worsens glycemic control and delirium.

Trusting the intake and output chart over the scale. Charts miss incontinence, insensible loss, and skipped measurements.

Mottled skin, delayed capillary refill, a new oxygen requirement, or confusion in an older adult, even with a normal temperature.

Calling every elevated troponin an NSTEMI. Chronic kidney disease, sepsis, heart failure, and pulmonary embolism raise it without plaque rupture.

Sending home a low-score patient who has hypoxemia, no support at home, or an inability to take oral medication.

No improvement in 48 to 72 hours, sepsis, or an obstructing stone needs CT and urology.

Do not discharge on score alone when the patient is on anticoagulants or has no safe follow-up.

Red cell casts, proteinuria, or hematuria suggests glomerulonephritis and needs nephrology.