At the time of admission, admitting hospitalist has to decide if patient needs to be kept in the hospital on observation vs admission status.
Observation status:
If patient needs more than 2 midnight stay in the hospital, put them under observation.
The patient can be even in ICU under observation status if they could potentially be discharged if they need less than 2 midnight stay.
Physician advisors and Utilization Management nurses check almost all the patients to see if the patients are placed in appropriate status or not. You may get a text or page from them if status needs to be changed. Change the status ASAP in those cases.
Patients ideally need to be informed about Observation status at the time of admission in ER before the patient goes to the floor.
Some common conditions under this status are TIA, Syncope, dizziness, breakthrough seizure, chest pain, simple cellulitis, ambulatory dysfunction due to pain, etc.
Admission status:
All the patients that you think will need more than 2 mid night stay need to be placed under admission status.
Commercial insurance companies are little bit strict about allowing a lot of patients into this status. They may deny if patient is discharged immediately after 2 midnight stay.
Patient usually has to meet ‘severity of illness’ and ‘intensity of treatment’ to qualify for this.
Some examples are acute CVA, Respiratory failure due to CHF, COPD exacerbations, severe infections, etc.
Any condition can be either obs or admission depending on the situation. In general, the longer the stay the more likely it will be admission.
