Inpatient Status

Posted on May 5, 2016 in Uncategorized | 0 comments

  • Appropriate for:
    • A patient whose medical condition, safety or health would be significantly threatened if care is provided in a less intensive setting, ­and
    • Who requires 2 or more midnights of medically necessary services in the hospital
  • Orders in Sutter EHR (EPIC)
    • Admit to Inpatient
    • Admit Direct
    • Admit to Inpatient from Observation
    • Includes Emergency & Laboratory/Radiology services, MD Office visits, and Same Day Surgeries, Observation, Ambulatory Surgery, Outpatient in a Bed
  • Observation is appropriate for:
    • Short term evaluation and/or treatment
    • Further work up is needed before a decision can be made to admit or discharge
    • Decision to admit or discharge made within 48 hours, usually < 24 hours
      • Examples: Abdominal Pain, Chest Pain, Gastroenteritis
    • Unexpected complication following an outpatient procedure
      • Examples: Delayed recovery from anesthesia, protracted vomiting
  • Observation is not appropriate for:
    • Medically stable patients requiring diagnostic or outpatient procedures
    • Procedures routinely performed as an outpatient
      • Laparoscopic cholecystectomy, Kyphoplasty, Pacemaker battery replacement
    • Patients awaiting placement: SNF, Board & Care, Conservatorship, etc.
  • Orders in Sutter EHR (EPIC)
    • Initiate Outpatient Observation
    • Change Patient Class from Inp to Obs
  • Outpatient in a Bed (OIB) or Ambulatory Surgery is appropriate for:
    • Patients within the “recovery” state following an outpatient procedure or surgery
      • Appendectomy, Thyroidectomy, TURP
      • Non-emergent, elective Cardiac Catheterization
  • Patients who need an overnight stay after an Outpatient procedure (late case)
  • Patients who do not meet medical necessary criteria for Inpatient or Observation and have non-clinical or social issues presenting barriers to discharge
    • Examples: Failure to thrive, patients dropped off in the ED for placement
  • Orders in Sutter EHR (EPIC)
    • Outpatient in a Bed
    • Ambulatory Surgery

By Manj Gunawardane, M.D., Summit Hospitalist Director; Physician Advisor, Utilization Management

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