Harbor:Observation placement: Difference between revisions

Latest revision as of 00:26, 7 March 2024

WE NO LONGER HAVE OBSERVATION STATUS/PLACEMENT. Patient needs to be admitted per Utilization Management/Interqual Guidelines.

Goal of our observation/Short Stay is admission avoidance
Consider a brief additional stay in the ED if it will prevent an admission
All Placement patients should go here unless explicitly instructed by the OBS attending to admit due to specific needs
(Previous: When boarding >5 obs patients in ED, admit DHS empaneled OBS-level patients)

References

Authors:

@@ Line 1: / Line 1: @@
-==Background==
+'''WE NO LONGER HAVE OBSERVATION STATUS/PLACEMENT. Patient needs to be admitted per Utilization Management/Interqual Guidelines.'''
+<small>
+* Goal of our observation/Short Stay is admission avoidance
+* Consider a brief additional stay in the ED if it will prevent an admission
+* All Placement patients should go here unless explicitly instructed by the OBS attending to admit due to specific needs
+* (Previous:  When boarding >5 obs patients in ED, admit DHS empaneled OBS-level patients)
+</small>
-*Any OOP patients needing observation or CORE services should be transferred to an in-network hospital if they are stable - [Peterson 5/2016]
-*Only patients with internal medicine (or family medicine) covered illness can be placed on obs.  All other services require admission (or transfer) [Lewis 5/2016]
-*Patients who would have been admitted but are pending a transfer that is delayed should NOT be placed on OBS just for that reason. These transfers often do not occur quickly. Only place such patients on OBS if they would have been OBS appropriate by their medical condition. [Peterson 2/2019]
-===Observation Service Guidelines===
-"Yes" to OBS
-* '''Placement:'''  '''All patients requiring placement should go to OBS'''
-* Patients should be placed on the most appropriate unit by the ED;  if specialty services are not available in the desired timeframe (ie, GI, IR), the observation team may make the decision to admit such patients (Lewis - 10/2017)
-* TB rapid rule-out (GenExpert PCR) takes about 12 hours. Order:
-**AFB bundle
-**Saline chloride 10% for RT
-**2 specimen cups with 1ml and 5ml total expectorate
-Do '''NOT''' Place on OBS (Admit instead)
-* Coumadin bridging requiring heparin drip (Lewis - 7/2017)
-* Multi-drug resistant history requiring antibiotics while awaiting culture results (Lewis - 7/2017)
-*Patients needing first ever dialysis (Spiegel/Daar  1/2019)
-Chappell, 8/2017, Peterson 1/2019
 ==See Also==