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Inpatient Vs. Extended Recovery Observation periodic monitoring by a hospital s nursing and other ancillary staff, which is reasonable and necessary to evaluate an outpatients condition or determine the need for possible admission Decision usually made in < 23 hoursL   !/Observation Vs. Inpatient Vs. Extended Recovery Inpatient- patients that require an acute care bed beyond the initial 23 hours and meet specific inpatient guidelines for admission .~ y (  J "/Observation Vs. Inpatient Vs. Extended RecoveryExtended Recovery- Placement in a bed following an outpatient diagnostic, therapeutic or ambulatory surgical procedure that requires a stay beyond the routine 4-6 hours of recovery time.B Extended Recovery (cont)Correct order post op/procedure = Extended Recovery Also known as  outpatients in a bed Utilizes Medicare listings of services, outpatient vs. inpatient for all elective admission requests  Reserves a bedZ$#Extended Recovery (cont)Can be upgraded For overnight stay-anytime past the routine 4-6 hours of recovery time is not reimbursed Utilizes an acute care bed Start in the clinic to explain to the patient and family surgery is considered outpatient, prepare for discharge early on.&ZW ADMISSIONS GUIDELINESMUNC Hospitals is a licensed facility for use of Interqual Admission GuidelineNN$4"ADMISSIONS GUIDELINESTwo main criteria are used in Interqual SI=Severity of Illness, clinical or laboratory findings IS=Intensity of Service, what is/are the treatment plan(s) indicatedZ(}($  %  .  ~'INTERQUAL GUIDELINES Interqual is available on all clinical workstations Applies to observation patients and inpatients Documentation is the key to ensuring reimbursementZ$ Observation ManagementWritten order by physician, i.e.  admit to observation status Documentation must include medical necessity(Severity of Illness, SI) and Treatment plan(Intensity of Service, IS) Orders must be written prior to initiation of observation hours( Observation ManagementiUsed in the following circumstances Outpatient Surgery Outpatient Therapeutic Services Patient Evaluation,$F$(F$5# Observation Management (cont) Outpatient Surgery restricted to when a patient exhibits an uncommon or untoward or unusual reaction to surgical intervention fZZlZZ($l$$) Observation Management (cont)Outpatient Therapeutic Services Restricted to when a significant adverse reaction occurs that is above and beyond the expected response to service  $,* Observation Management (cont)Patient Evaluation Evaluate the patient when the provider is unsure about admission and additional time is needed to make that determination Provider believes patient will respond to treatment modalities in less than 23 hours 4$Observation HoursCommon misunderstanding is that Medicare covers up to 48 hours in observation status. This is correct, but only in rare circumstances with significant documentation to support the need Medicare expects that observation services generally do not exceed 24 hours$s+Observation Hours (cont)UNC Hospitals policy is that a decision regarding observation patients can and should be made within 24 hours. Discharge patient Admit as an inpatient only if inpatient criteria has been met.^pZRZp$$$$$"$Writing Observation OrdersCorrect  Admit to Observation Status Incorrect  Overnight observation  To unit T  " ($ ("$6$!Writing Observation Orders (cont)""Incorrect  Admit to 23 hour observation for extended recovery  Transfer  Overnight stay * Q (Q$,!Writing Observation Orders (cont)""*NOTE Occasionally patients in observation status need to be transferred from a general nursing unit to a critical care/step-down unit. Physicians orders should state  Admit to and NOT  Transfer to____ . \$$$$E How does a patient go from Observation status to Inpatient status??FD(Observation team of Registered Nurses review ALL observation and extended recovery cases in-house Utilize Interqual Guidelines Observation team will make a recommendation to upgrade the patient to inpatient status if criteria are met (review clinical documentation and orders written):Z&D -E How does a patient go from Observation status to Inpatient status??FD(cWill recommend discharge if criteria not being met for continued stay Review of status alert sheetsdd$.E How does a patient go from Observation status to Inpatient status??FD(Physician must write an order for inpatient admission(Admit to______)including those patients in observation status going to a critical care unit. Observation status can progress to inpatient status----a patient can never go from inpatient to observation status6 &(BMC Observation team Pager Hours 216-2669 Days 216-1939 Days 909-0108 Evenings 123-2251 Weekends 0700-1930 Admission Coordinator WP 966-4029Xi BED ASSIGNMENT AREA 966-2041,Formally known as Bed Control 10.5 FTE s 24/7 operation 687 acute care beds Work closely with NURSING supervisors Daily Bed Planning meeting at 0830  SCREENING OF ADMISSIONSUse of Interqual guidelines M-F 0800-1700 Call Center in operation(966-2041), with options All other hours RN coverage as indicated(on call)$2 SCREENING OF ADMISSIONSSI=Severity of Illness(Dx., S/S) IS=Intensity of Service(TX. Plans) Primary responsibility to determine Observation vs. Inpatient status Correct orders must follow recommendation$ DATA COLLECTION AND REPORTSrObservation Management database CRM database Bed Availability Transfer data Quality Assurance(Impact Care reports)ss$9Authorizations for Urgent/Emergent Admissions & TRANSFERS*:0$ $BMC is responsible to authorize all Urgen /Emergent admissions M-F 0800-1700 Specific demographic & clinical information required along with proposed treatment plans(IS/SI) All patients start out as Observation and are upgraded to Inpatient as indicated $3!9Authorizations for Urgent/Emergent Admissions & TRANSFERS*:0$ $}All transfers are screened utilizing Interqual guidelines to ascertain the need for Tertiary care Physician Advisor available~~$% O/ * ` hff$Idj` [RIȺ*=zdj` 333___` }a$Idj` [RIȺ*=zd3333>?" dd@,?nK!d @  h`Fff_d <7d7 n?" dd@   @@``PP   @ ` ` p>>    D (    T%d "` >    # l(d "  >    # ,?A?Stationery"   >    ^d.AStationery"  >    6\1 "  T Click to edit Master title style! !  65 "P  ^*   6t9 "p   `* x  C BA*C:\Wendy\anabnr2.GIF"  <l="  >    6\B "@  l*( N  Z@F ??",L  RClick to edit Master text styles Second level Third level Fourth level Fifth level!     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Inpatient Vs. Extended Recovery0Observation Vs. Inpatient Vs. Extended Recovery0Observation Vs. Inpatient Vs. Extended RecoveryExtended Recovery (cont)Extended Recovery (cont)ADMISSIONS GUIDELINESADMISSIONS GUIDELINESINTERQUAL GUIDELINESObservation Management Observation Management Observation Management (cont) Observation Management (cont) Observation Management (cont)Observation HoursObservation Hours (cont)Writing Observation Orders"Writing Observation Orders (cont)"Writing Observation Orders (cont)F How does a patient go from Observation status to Inpatient status??F How does a patient go from Observation status to Inpatient status??F How does a patient go from Observation status to Inpatient status??BMC Observation teamBED ASSIGNMENT AREA 966-2041SCREENING OF ADMISSIONSSCREENING OF ADMISSIONSDATA COLLECTION AND REPORTS:Authorizations for Urgent/Emergent Admissions & TRANSFERS:Authorizations for Urgent/Emergent Admissions & TRANSFERS  Fonts UsedDesign TemplateEmbedded OLE Servers Slide Titles" _KCraddocKCraddoc  !"#$%&'()*+,-./0123456789:;<=>?@ACDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root EntrydO)Pictures6Current UserSummaryInformation(pRPowerPoint Document(B5DocumentSummaryInformation8