Harbor:Observation placement: Difference between revisions

(Text replacement - "Harbor:Operations manual" to "Harbor:Main")
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==Background==
==Background==


*Any OOP patients needing observation or CORE services should be transferred to an in-network hospital if they are stable - Peterson 5/2016
*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
*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]
*If the hospitalist is capped (cap is 20 if single overnight hospitalist coverage, which includes Obs and CORE leftover from dayshift, new Obs or CORE, and new admissions), and you have a patient you’d like to place in Observation, CORE, or an admission:
*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]
**Do not place the order for obs placement, CORE, or the ‘request for admit’ order. This becomes confusing for nursing who is actually managing the patient. Only place this order when you have discussed the patient and the care officially transfers to the inpatient/obs/CORE physician.
**Continue to manage the patient until the next hospitalist shift starts (typically 7:30am) or the next medicine slot is available.
**Do put in an Attending Admit Note at the time of the actual admit decision but document in your notes that patient is being held in the ED due to lack of hospitalist/Medicine capacity.
 
===Observation Service Guidelines===
===Observation Service Guidelines===
"Yes" to OBS
"Yes" to OBS

Revision as of 21:35, 30 April 2019

Background

  • 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

References

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