Admission assessment
A real history and physical on arrival, with the hospital course reconciled rather than copied forward.
Service line 06
Primary care that stays in the building
Most of what sends a resident to the emergency department starts as something small that nobody had time to look at. Our primary care clinicians round on a fixed schedule, manage chronic disease in place, and handle acute changes before they become transfers.
What we treat
Primary Care covers a wide range
Every referral is assessed on its own merits. If a resident needs a different specialty or a higher level of care, we say so plainly.
What we manage
- Admission and annual history and physical
- Diabetes and metabolic disease
- Hypertension and lipid management
- COPD, asthma and chronic respiratory disease
- Chronic kidney disease
- Thyroid and endocrine disorders
- Anemia and nutritional deficiency
- Acute changes in condition
- Polypharmacy and medication burden
- Preventive care and immunisation
At the bedside
What we do at the bedside
What the clinician actually does in the room.
Chronic disease management
Scheduled review of every active problem, with targets written into the chart.
Acute change visits
Seen in the building on the day where the condition allows it, instead of defaulting to a transfer.
Medication reconciliation
Every list reconciled at admission and at each change in level of care.
Deprescribing
Pill burden reduced deliberately, with the rationale documented for the family and the surveyor.
Lab and imaging oversight
Ordered in the building, followed up on, and acted on — not left to appear in a pile.
Specialist coordination
Referrals made and results brought back into one chart rather than five.
Goals of care
Advance directives revisited as the resident changes, not only at admission.
Family communication
A named clinician the family can actually reach about the whole picture.
Care pathway
How a primary care referral moves
Sequential by design — every step is a hand-off with a named owner, so nothing sits waiting for someone to notice it.
- 1
Attending or consulting role
We serve as the attending of record, or alongside your existing attendings — your choice, per resident.
- 2
Admission visit
Full assessment within the required window, with orders and a problem list written the same day.
- 3
Scheduled rounding
A recurring day per building, sized to your census and regulatory visit requirements.
- 4
Acute response
Phone access between visits, and a same-day look at changes in condition where it is safe to do so.
- 5
Medication review
Every regimen revisited at each visit, with deprescribing opportunities acted on.
- 6
Transitions
Hand-off written for the hospital, the family, or hospice — whichever comes next.
Settings served
Skilled nursingAssisted livingMemory careLong-term carePrivate residence
Primary care is the line that ties the others together — one clinician holding the whole problem list while the specialties work their part of it.
Keep looking
Other service lines
Wound Care
Bedside wound management with sharp debridement, advanced modalities and measurable weekly progress. Our largest and longest-running line.
Read morePodiatry
Routine and at-risk foot care delivered in the room, so no resident leaves the building for a nail trim or a diabetic foot check.
Read morePhysiatry
PM&R consults that keep function, pain and rehab goals moving in the right direction, worked directly with your therapy team.
Read moreReady to add primary care to your building?
Send us your setting and census and we’ll come back with a rounding plan.