4A has a reputation among MDs as being incredibly difficult to refer patients to. There are idiosyncratic admission criteria that sometimes do not have clinical relevance (ie requesting pts on dialysis to get a repeat lab draw AFTER dialysis to ensure the potassium is ok, not allowing patients newly on O2 to be referred even if they've just recovered from ARDS 2/2 PNA in the ICU, only accepting patients on q8h antibiotics rather than q12h, etc). 4A certainly has a right to define its admission criteria but if SFGH as a system is to become more efficient, it seems LLOC patients should not occupy acute beds in the main hospital but instead take one of the 4A beds that often are available. 4A also seems a more appropriate place than acute hospital beds for patients awaiting placement or conservatorship.