Harbor:Observation placement: Difference between revisions

Revision as of 00:56, 25 January 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
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:
- 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

"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

References

Authors:

@@ Line 8: / Line 8: @@
 **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 Placement Guidelines===
+===Observation Service Guidelines===
-* There is no cap on observation patient numbers
+"Yes" to OBS
-* '''Placement:'''  All patients requiring placement at an extended care facility should go to OBS even if they require physical therapy assessment for placement
+* '''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, and 2 specimen cups with 1ml and 5ml total expectorate
+* TB rapid rule-out (GenExpert PCR) takes about 12 hours. Order:
-* Coumadin Bridging requiring heparin drip (not low molecular weight heparin or NOAC candidates) - '''ADMIT''' (Lewis - 7/2017)
+**AFB bundle
-** Please do your best to prescribe rivaroxaban (Xarelto) to avoid this as it is available on our DHS formulary.
+**Saline chloride 10% for RT
-* Multi-drug resistant history requiring antibiotics while awaiting culture results - '''ADMIT''' (Lewis - 7/2017)
+**2 specimen cups with 1ml and 5ml total expectorate
-** MDR infections such as ESBL, VRE, CRE, etc., admit to medicine if you are worried about a repeat MDR infection (ie.,: urine culture in pyelonephritis patient)
+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
+Chappell, 8/2017, Peterson 1/2019
 ==See Also==