outpatient observation

Outpatient Observation Services : 

Outpatient Observation Services

Outpatient Observation Services : 

Outpatient Observation Services Observation services can be provided for patients that require a significant or prolonged period of treatment or monitoring in order to make a decision concerning their admission or discharge.

Types of Patients : 

Types of Patients The initial types of patients expected to transition to the observation program will include but not limited to: Chest Pain (R/O MI) Arrhythmia Syncope Post Operative Related: Uncontrolled pain Unstable Vital Signs Bleeding Arrhythmia

Guidelines for Services : 

Guidelines for Services Order must be provided by the physician for observation services In the majority of observation patients, the decision to discharge or admit a patient can be determined in less than 24 hours.

Guidelines for Services : 

Guidelines for Services In rare or exceptional cases it might be necessary to expand the services to 48 hours or more.

Due to Time Limitations : 

Due to Time Limitations All test and procedures must be done in an expeditious manner so that the physician can determine if the patient can be discharged or needs to be admitted as an inpatient.

Contact the In-House Supervisor : 

Contact the In-House Supervisor Provide the following information: Attending physician (usually hospitalist) and type of service required, i.e. medical / surgical or Telemetry. A diagnosis that supports Outpatient Services.

Communication to Nursing Unit : 

Communication to Nursing Unit The nursing supervisor must clearly communicate to the nursing unit that the patient is an observation patient (not an in-patient).

Case Management Department : 

Case Management Department The Case Management Department will provide screening to ensure that the patient is placed in the most appropriate service and level of care.

Procedure : 

Procedure Order must be obtained by a physician. “Admit to Outpatient Observation Services”.

Physician Orders : 

Physician Orders The patient must be under the care of a physician during the Observation period. The physician will usually be a Hospitalist but can be any privileged physician. Orders must reflect the need for Observation, and dated, timed, and signed. If after the first 24 hours has lapsed, and more time is needed, the physician must document the medical necessity.

Specific Observation Admission Order : 

Specific Observation Admission Order

Power Plan Admission Orders Specific to Level of Care : 

Power Plan Admission Orders Specific to Level of Care

Surgical Patients : 

Surgical Patients Surgical patients should not be pre-registered as Outpatient Observation patients . Only after the patient arrives in the PACU (recovery area) can the determination be made regarding the need for Observation Services

23 hour Admissions : 

23 hour Admissions Effective immediately, there will be no 23 hour admissions. Patients that require longer stays because of specific conditions will need to be evaluated by the physician to determine the need for observation, longer recovery, admission or discharge.

Arrival on the Unit : 

Arrival on the Unit When the Observation patient arrives on the nursing unit, the unit clerk / nurse will enter the “Observation Patient Arrival” order in the CPOE system.

Nursing Assessment : 

Nursing Assessment A routine (Full) admission assessment will be required for observation patients. This is to assure that the nursing staff are aware of the patients needs, since the patient may be under their care for 24-48 hours.

MD Order : 

MD Order Once the patient has reached the 23 hour period, the MD will re-evaluate the patient to determine if the patient needs to be admitted, discharged, or remain as an observation patient. A written order will be required (CPOE) to provide for this extension.

History and Physical : 

History and Physical A full history and physical is required for an observation patient (written or dictated).

Changes in Status : 

Changes in Status An Observation patient status can easily change from Observation status to In-patient status if the patient has been determined to meet the criteria. An order is required to “admit as an in-patient”.

Changes in Status : 

Changes in Status An in-patient can be converted to an Observation patient only if the decision is made prior to discharge and with consultation with the Case Management / Utilization Review Committee.

Reconciliation : 

Reconciliation If an patient converts from an observation patient to an inpatient, all observation orders must be suspended / discontinued and new orders written for the inpatient stay.

Discharge from the Unit : 

Discharge from the Unit When the physician writes the order for discharge, the documents are completed. The date / time of the discharge documents will be the end time of the observation experience.