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Procedural elements of observation units

Hospitalist Leadership Connection, May 25, 2010

An effectively run observation unit must have clearly delineated policies and procedures. These policies should choreograph the process from patient registration through the discharge of the patient from the unit. There should also be a designated clinician (e.g., hospitalist) and nonclinician (e.g., from nursing or case management departments) leader. The following are examples of guidelines:

• The attending physician, ED physician, or resident “assigns” an outpatient to observation status. The observation unit physician (e.g., hospitalist) confers with the individual requesting admission and they jointly come to a decision to assign to the observation unit or that some other care setting is most appropriate for the patient.
• Patients placed in observation status will receive a package from the admitting interviewer that will include a brief form letter explaining the observation status, advance beneficiary notice, preadmission, and notice of noncoverage
• The nursing chart will be labeled “Observation” until a decision is made to admit
• Observation status begins at the time the decision is documented, not at the time the patient first presents in the ambulatory care area of in the ED
• Resource utilization personnel (case management) will monitor the patient’s stay to ensure that the decision to “discharge” from observation status occurs within the appropriate time frame (23 hours), or that admission to the hospital as an inpatient takes place once the medical necessity for admission is determined.

The above excerpt is adapted from The Hospitalist Program Management Guide, 2nd edition, published by HCPro, Inc.

 

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