Case Management

Mentor moment: A 24-hour stay does not equal observation

Case Management Weekly, December 8, 2010

After years of discussion and attention given to observation services and inpatient status, there are still those who believe all 24-hour hospitals stays should be observation. However, examples of legitimate 24-hour inpatient stays exist. Consider the following.

James presents to the emergency department (ED) with persistent nausea and vomiting that is unresolved with antiemetics administered in the ED. He also has tachycardia with occasional premature ventricular contractions, a serum potassium level of 7.8, and a history of end stage renal disease. James also missed his last dialysis appointment. This patient meets inpatient criteria because his potassium level is critically high and his nausea and vomiting are unresolved.

The physician orders IV fluids, telemetry monitoring, vital signs monitored every four hours, and dialysis. The patient undergoes dialysis later that day, and by the next afternoon his potassium level is 5.1 and his nausea and vomiting have subsided. The physician discharges James that afternoon. Just because James was in the hospital for only 24 hours doesn’t mean he did not need inpatient care. Based on the signs and symptoms presented, the severity of James’ illness, and the intensity of services he received, inpatient admission is appropriate.

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