What Patients Can Be Managed?

Adolescent Medicine (Consult) 

Included in the King of Prussia Hospital Population:  

• Contraception
• Dysfunctional/Abnormal vaginal bleeding
• Dysmenorrhea
• Ovarian cysts (not surgical cases)
• Pelvic inflammatory disease
• Pelvic pain

Excluded from King of Prussia Hospital Population:  

• Ovarian cysts (surgical cases)

Consult Availability:

• Provider-to-provider available 24/7
• Telehealth Consults, 8 a.m. - 12 p.m. everyday
• Urgent Consults, Attendings on service will determine who is able to complete consult. Could be telehealth or in-person depending on provider availability.  

Included in the King of Prussia Hospital Population:  

• If there is uncertainty regarding best placement, patient to be admitted at the hospital where they initially presented.
• Patient may be transferred during admission if Philadelphia Campus is deemed more appropriate. 

Excluded from King of Prussia Hospital Population:  

• Patient who has used MBU in the past or will need MBU resources
• Comorbid diagnoses requiring multiple sub-specialty in-person consultation and support for optimized collaboration of care.
• If possible, any patients with history of long hospital length stays (over 14 days)

Consult Availability:

• Provider-to-provider available 24/7
• Telehealth Consults, 8 a.m. - 12 p.m. everyday
• Urgent Consults, Attendings on service will determine who is able to complete consult. Could be telehealth or in-person depending on provider availability.  

Included in the King of Prussia Hospital Population: 

• Asthma
• Acute hives
• Anaphylaxis
• Drug Allergy/Desensitization
• Immunology admissions considered on case-by-case basis

Excluded from King of Prussia Hospital Population: 

• Patients requiring positive pressure room

Consult Availability:

• Provider-to-provider available 24/7
• Telehealth available as needed

Included in the King of Prussia Hospital Population:  

• Stable biventricular circulation with non-cardiac admission
• Supplemental remote cardiac monitoring
• Additional considerations on case-by-case discussion with cardiology

Excluded from King of Prussia Hospital Population: 

• Cyanotic heart disease
• Arrhythmia
• Shunt-dependent congenital heart disease
• Single ventricle congenital heart disease

Consult Availability:

• Provider-to-provider available 24/7
• Telehealth available as needed

Included in the King of Prussia Hospital Population: 

• CPAP Patients
• Young patients with major ear surgery and young patients with cochlear implants
• Micro Laryngoscopy with supraglottoplasty or manipulation
• Deep Neck infections

Excluded from King of Prussia Hospital Population: 

• Airway procedures
• Triple scopes

Consult Availability:

• 24/7 on-site surgical APP with attending back-up available by phone
• In-person attending as available

Included in the King of Prussia Hospital Population:  

• Known diabetes patients with diabetic ketosis without acidosis
• Known diabetes patients with diabetic ketoacidosis (PICU admission)

Excluded from King of Prussia Hospital Population:  

• New onset diabetes
• Hyperinsulinism
• Hypoglycemia evaluation
• Diabetes insipidus

Consult Availability:

• Provider-to-provider available 24/7
• In person, as available
• Telehealth

Included in the King of Prussia Hospital Population:  

• ​Uncomplicated abdominal pain
• Gastroesophageal reflux
• Constipation/cleanout
• First time pancreatitis
• Failure to thrive/Nutritional rehabilitation
• Nasogastric tube/gastric tube feeds initiation

Excluded from King of Prussia Hospital Population: 

• Inflammatory bowel disease
• Patient cared for by Liver, Motility, Intestinal Rehabilitation Programs
• Transplant patients
• Home TPN
• Patients with concern for Esophageal Foreign Body

Consult Availability:

• Telephone/telehealth consultation: Weekdays from 8 a.m.-5 p.m.  
• Off-hours telephone consults provided by GI fellow
• Provider to Provider available 24/7 

Included in the King of Prussia Hospital Population:  

• Post op patients with sickle cell disease (simple procedures such as myringotomy tubes)
• Established Idiopathic Thrombocytopenic Purpura (ITP) requiring therapy
• Patients with fever and central line with or without Neutropenia
• Autoimmune neutropenia with fever and neutropenia
• Splenectomy with fever (not sickle cell) who require admission (typically can be discharged post Ceftriaxone).
• Iron deficiency anemia

Excluded from King of Prussia Hospital Population:  

• Patients with acute new onset thrombosis or cared for by the Philadelphia thrombosis team.
• Patients with bleeding disorders who are bleeding and require admission for close monitoring and treatment.
• Patients with sickle cell disease with an acute medical issue who meet criteria for hospitalization
• Patients with sickle cell requiring a major procedure (risk of ACS) and need admission post for observation.

Consult Availability:

• Oncology inpatient attending available in person during the day
• Telehealth consults for those consults not covered by the Oncology inpatient attending.
• Provider to Provider available 24/7

Included in the King of Prussia Hospital Population:  

• IV hydration in metabolism patients not requiring special formula

Excluded from King of Prussia Hospital Population: 

• Metabolic crisis
• Patients requiring special formula

Consult Availability:

• Telehealth
• Provider-to-provider available 24/7

Included in the King of Prussia Hospital Population: 

• Therapeutic hypothermia for hypoxic ischemic encephalopathy
• Seizure management
• Management of acute and chronic respiratory failure
• Sepsis/meningitis
• Preterm infants >/= 24 weeks and 800g born at outside hospital
• Non-urgent surgical patients (g tube placement, inguinal hernia repair)
• ROP screening and intervention including avastin and laser treatment
• Newborns and infants requiring consultative services (in person or via telehealth): hematology, neurology, pulmonology, endocrine, genetics, infectious disease, ophthalmology, cardiology, orthopedics, general surgery
• Feeding evaluations
• Sleep studies

Excluded from King of Prussia Hospital Population:

• Acute surgical concerns
• Critical airway management
• Double volume exchange transfusions
• Acute IVH, intracranial thrombi or perinatal strokes

Included in the King of Prussia Hospital Population:  

• Mild Rhabdomyolysis in otherwise healthy patient
• Acute pyelonephritis
• Transplant with dehydration/ Viral illness/Diarrhea
• Mild acute kidney injury
• Mild acute glomerulonephritis
• CKD patients with acute illness/dehydration

Excluded from King of Prussia Hospital Population:  

• Patients requiring dialysis

Consult Availability:

• Telehealth
• Provider-to-provider available 24/7

Included in the King of Prussia Hospital Population: 

• First seizure patients without need for inpatient workup
• Febrile seizures
• Well-established, stable, epilepsy patients
• Selected Epilepsy Monitoring Unit patients
• Botulism
• Patients requiring spot or video EEG

Included in the King of Prussia Hospital Population for ICU:

• New seizure or concern for seizure​ 
• Post-ictal and not at baseline​ 
• Status Epilepticus including intubated with midazolam infusion​ 
• Epilepsy with intercurrent illness and increased seizure burden​ 
• Altered mental status​ 
• Post-cardiac arrest (brief)​ 
• Infant botulism ​​​​​​​

Excluded from King of Prussia Hospital Population: 

• Complex/refractory epilepsy patients
• Patient requiring or potentially requiring Neurosurgical care
• Concern for stroke/acute neurologic syndrome
• New onset severe headache
• Spinal cord symptoms
• Suspected neuromuscular disorder (ex: Guillain Barre Syndrome, botulism)
• Demyelination disorders
• Persistent altered mental status
• Scheduled EEG monitoring​  
• Neuro-related complaint requiring urgent work up (sedated MRI over weekend, sedated LP on floor) 
• Patient with epilepsy on ketogenic diet (except exclusively on KetoVie 4:1 formula PO/GT)
• Patient with epilepsy requiring VNS evaluation 
• Patient with migraine requiring nerve block ​  
• Encephalopathy without clear etiology
• Patient requiring or potentially requiring neurosurgical evaluation 

Excluded from the King of Prussia Population for ICU:

• Per discretion of neurology and KOPH team ​
• Status Epilepticus with management beyond midazolam​ 
• Weekend or overnight initiation of EEG
• Weekend or overnight in person consultation needed ​​​​​​​

Consult Availability:

• Provider to Provider available 24/7
• In-person consults available Monday-Friday from 8 a.m to 5 p.m.
• Phone consults during other hours

EEG:

• Available most Monday-Friday from 8 a.m - 4 p.m including urgent routine EEGs and EEG monitoring.

Included in the King of Prussia Hospital Population: 

• Low risk patients with fever
• Routine scheduled chemotherapy admissions
• Nutritional/hydration support
• Nausea/vomiting
• Prolonged infusions/simple transfusions
• Pain/mucositis management
• Post PEG asparaginase reactions
• Newly diagnosed ALL that meet King of Prussia hospital eligibility
• End-of-life care requiring hospitalization

Excluded from King of Prussia Hospital Population:

• New oncology diagnoses except newly diagnosed ALL that meet King of Prussia Hospital eligibility
• High risk patients with fever that may require in person consultations not available at King of Prussia hospital
• Patients receiving daily radiation
• Bone marrow transplant and CART patients
• Neurooncology patients
• Patients requiring interventional radiology consultation
• Neuroblastoma on immunotherapy
• Vascular malformations
• Patients requiring positive pressure room
• Patients with acute bleeding that need sustained blood product support i.e. cannot wait several hours for products after initial emergency transfusions
• Patients with acute neurologic toxicity requiring in-person neurology consultation

Consult Availability:

• King of Prussia Onco IP SvcAttending: in person, 8 a.m. – 5 p.m.
• BMT team at Philadelphia Campus 
• Neuro-Onc team at Philadelphia Campus 
• CART MD: daytime M-F; Onco fellow nights/weekend
• PC Solid team
• CVAP MD: daytime M-F; Onco fellow nights/weekend

Included in the King of Prussia Hospital Population:

• Fractures and other non-emergent add-on cases (e.g. SCFE, septic joints, etc.)
• Sports injuries
• Limb reconstruction (all hip, foot and limb reconstruction procedures)
• Benign bone lesions, biopsy of potential malignancies, pathological fractures
• Simple growing spine: VEPTR expansion
• Ambulatory CP surgeries: muscle lengthening/ osteotomies
• OR casting (e.g. scoliosis and Spica cast placement)
• Implant removal

Excluded from King of Prussia Hospital Population:

• Spinal deformity correction
• Emergent fractures that require surgery
• Inpatient rehab patients admissions after surgery
• Microvascular surgery
• Multi-trauma patients

Consult Availability:

• 24/7 on-site surgical APP with attending back-up available by phone
• In-person attending as available

Included in the King of Prussia Hospital Population:

• Cleft lip and palate repairs/ Cleft lip adhesions
• Alveolar cleft repair
• Rhinoplasty with autograft/ nasal reconstruction
• Extracranial contouring
• Removal of mandibular distractors
• Removal of hardware
• Breast reduction
• Stage 1 facial reanimation
• Facial fractures or repairs
• Wound debridement/ VAC applications
• Oral tumor removal
• Le Fort I and II
• Cleft lift for pilonidal disease
• Tissue expander placement and removal
• Cleft palate repair and BSSO

Excluded from King of Prussia Hospital Population:

• Any procedure not listed in the "Included in the King of Prussia Hospital Population" column

Consult Availability:

• 24/7 on-site surgical APP with attending back-up available by phone
• In-person attending as available

Included in the King of Prussia Hospital Population:

• Acute respiratory failure requiring HFNC, CPAP, BiPAP
• Acute respiratory failure requiring invasive conventional ventilation
• CPAP/BiPAP initiation for OSA
• DKA in patients with known diabetes
• Post-operative patients who require ICU care
• Chronic respiratory failure (non-invasive or T/V) with intercurrent illness
• Septic shock

Excluded from King of Prussia Hospital Population:

• Difficult/Critical airway status w/o tracheostomy
• Tracheostomy with home training needs
• VV or VA ECMO
• Unrepaired CHD, single ventricle physiology, cardiomyopathy, or lethal arrhythmia
• Active cardiac disease, pulmonary hypertension, lymphatics patients
• Neurosurgery patients or acute TBI
• Neuro eval for ICH, stroke, status epilepticus that does not return to baseline, unexplained encephalopathy or demyelinating disorders
• Post cardiac arrest
• Trauma
• Organ transplant evaluation (lung, acute liver failure, etc.)
• Dialysis need
• New onset DKA

Consult Availability:

N/A

Included in the King of Prussia Hospital Population:

• Asthma
• Sleep study finding requiring urgent intervention (CPAP or T&A)
• Uncomplicated pneumonia or bronchiolitis
• Select technology dependent patients (ICU)

Excluded from King of Prussia Hospital Population:

• Cystic fibrosis
• Transplant patients
• Primary ciliary dyskinesias
• Interstitial lung disease
• Bronchiolitis obliterans
• Pulmonary alveolar proteinosis
• Pulmonary hemorrhage
• Foreign body aspirations
• Congenital central hypoventilation syndrome
• Pulmonary hypertension requiring more than sildenafil therapy
• Muscular dystrophy patients with respiratory complaints
• Respiratory complaints in transplant, muscular dystrophy, CDH or giant omphalocele patients

Consult Availability:

• Provider-to-provider available 24/7
• In-person Consults available Monday - Friday with APP
• Attending available Mondays and Thursdays 

Included in the King of Prussia Hospital Population:

• Uncomplicated Kawasaki’s Disease
• Uncomplicated HSP
• Suspected rheumatologic/inflammatory disorder to determine need for transfer to Philadelphia Campus

Excluded from King of Prussia Hospital Population:

• Patients who require in-person evaluation by Rheumatology team 

Consult Availability:

• Provider-to-provider available 24/7
• Telehealth

Included in the King of Prussia Hospital Population:

• Hypospadias/Chordee/Circ
• Orchiopexy/Orchiectomy
• Hernia/Hydrocele
• Vesicostomy or revision
• Ureteral implant
• Ureterostomy
• Cystoscopy/retrograde/stent/uncomplicated ureteroscopy
• Uncomplicated laparoscopy (UDT, hernia, reimplant, nephrectomy)

Excluded from King of Prussia Hospital Population:

• Any robotic procedure
• Any stone procedure
• GU trauma
• Abdominopelvic reconstruction

Consult Availability:

• 24/7 on-site surgical APP with attending back-up available by phone
• In-person attending as available