Direct admissions

I wonder if anyone has thoughts on what kind of patient should be a direct admission and what kind needs to go to the ER?

It just seems like it's always when I'm seeing acutes in clinic when I'm busy and I have the least amount of time to think about it and it's such an ordeal.

It seems to depend on the consultant precepting (if they're bossy) and the consultant on the service (if they know the scoop).

It seems kind of crappy to send someone to the ER if it's not an emergency (but maybe it is a Friday or Saturday or something)

I definitely realize the service census is important.

It's totally clear who absolutely needs to go to the ER (super sick, unstable, etc)

I think it'd be nice if there was an algorithm or something to avoid the unnecessary hassle.

If the census is more than 7: to the ER. (If 5 or more admissions already: to the ER?)

If no relevant labs/workup available (or can't get relevant workup): to the ER

What else? It just seems like there should be a protocol in place to take away hassle, drama, extra time (when you don't have it in clinic/in the hospital).

If anybody's reading this, I'd love to hear thoughts. Where I'm going next year, everyone just goes to the ER. Here, I think consultants take it as a matter of pride that we have a service to admit to.