In my area direct admission is impossible. If I send a patient to admitting with orders and I would like them admitted they will simply be sent to the ER where they will have to be seen by the ER doctor. The "direct admit" lives only in fantasy in this area. Patients are inconvenienced but I am sure it's a net revenue generator for the hospital.

As a hospitalist in a small rural community, I can see it both ways. I don't want patients to have the extra financial burden of an ER work-up prior to admission. But I also don't want to have a patient arrive to the floor needing urgent ICU transfer. Often, when the decision is made to send the patient to the hospital, the primary care physician doesn't yet have the data to determine the best admission status for a given patient. And, as a critical access hospital without a full slate of specialty care, it is always easier to ship a patient from the ER to a tertiary care facility if they have a need that can't be met here. Once they are actually admitted to our hospital, transferring from in-patient to in-patient is a sometimes a nightmare. And that delays appropriate care, too. My policy is to accept direct admits from primary care physicians with whom I have a good working relationship and who have demonstrated that they send me patients "as advertised".