Harbor:Observation placement

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)
  • Patients that are OOP
    • For patients who are (1) not safe for discharge home; (2) stable for transfer or can be stabilized for transfer; and (3) empaneled to an outside system
      • Ask, via UR, that the patient be transferred for hospitalization within their empaneled system
      • Clearly document why the patient’s medical condition makes it impossible to safely discharge them from the ED, and why they need acute medical care or additional evaluation.
      • Ask, via UR, that the empaneled system grant approval for inpatient admission if they are unable to accept the patient in transfer.
      • If the empaneled system both refuses to accept their patient in transfer (e.g., they have no capacity) and refuses to give approval for inpatient admission (e.g., the patient doesn’t meet their own internal criteria for requiring admission), then UR will determine whether the patient should be admitted or placed on OBS/CORE, based on our internal assessment of the likelihood that we will be able to successfully appeal the initial denial for authorization. If we believe that a successful appeal is likely, we will admit the patient to an inpatient service to continue to preserve OBS/CORE capacity for DHS patients. (Dr. Lewis 9/2019)


Chappell, 8/2017, Peterson 1/2019

See Also

References