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    Observation Bed Policy: Hospital Policy Manual Policy Number: 2.2 Effective Date: 10/01/08

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    valnoel
    This hospital policy outlines guidelines for observation bed status. Observation is intended for patients who require up to 24 hours of monitoring to determine if they need inpatient admission or further treatment. The policy defines observation stays and provides criteria for appropriate observation patients, including those with certain diagnoses that should not be placed in observation. It also describes requirements for physician orders, documentation, and converting a patient to inpatient status if their condition changes.

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    Observation Bed Policy: Hospital Policy Manual Policy Number: 2.2 Effective Date: 10/01/08

    Uploaded by

    valnoel
    110 views3 pages
    This hospital policy outlines guidelines for observation bed status. Observation is intended for patients who require up to 24 hours of monitoring to determine if they need inpatient admission or further treatment. The policy defines observation stays and provides criteria for appropriate observation patients, including those with certain diagnoses that should not be placed in observation. It also describes requirements for physician orders, documentation, and converting a patient to inpatient status if their condition changes.

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    Bed Policy

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    This hospital policy outlines guidelines for observation bed status. Observation is intended for patients who require up to 24 hours of monitoring to determine if they need inpatient admission or further treatment. The policy defines observation stays and provides criteria for appropriate observation patients, including those with certain diagnoses that should not be placed in observation. It also describes requirements for physician orders, documentation, and converting a patient to inpatient status if their condition changes.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    110 views3 pages

    Observation Bed Policy: Hospital Policy Manual Policy Number: 2.2 Effective Date: 10/01/08

    Uploaded by

    valnoel
    This hospital policy outlines guidelines for observation bed status. Observation is intended for patients who require up to 24 hours of monitoring to determine if they need inpatient admission or further treatment. The policy defines observation stays and provides criteria for appropriate observation patients, including those with certain diagnoses that should not be placed in observation. It also describes requirements for physician orders, documentation, and converting a patient to inpatient status if their condition changes.

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    of 3

    Hospital Policy Manual

    Policy Number: 2.2


    Effective Date: 10/01/08

    LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER -


    SHREVEPORT

    OBSERVATION BED POLICY

    Purpose:

    The purpose of observation beds is to provide facilities for those


    patients who require a period of observation to determine the need for
    further treatment or a possible admission to the hospital as an inpatient.

    Definition:

    Observation stays are generally twenty-four (24) hours or less. The time
    period begins when the patient enters the Observation Bed and ends
    when the Physician’s Order to end the status is written. Such services
    may exceed twenty-four (24) hours only under extenuating circumstances,
    for which medical and safety issues prohibit release of the patient. Social
    issues, patient convenience, and transportation problems do not justify
    payment for observation services. Registrations of observation status
    must be ordered by a physician (or other individual with privileges to admit
    and order outpatient tests). The rationale for registrations to OBS must be
    clearly documented in the medical record. Observation status may NOT
    be used when a patient meets an acute level of care in accordance with
    the Hospital’s admission criteria.

    Policy:

    Criteria for Observation Status:

    1. Patients not meeting inpatient admission criteria but are exhibiting


    clinical signs/symptoms that would justify admission if they worsen
    or fail to resolve.

    2. Standing orders for observation following outpatient surgery are not


    permitted.

    NOTE: Patients that are to undergo a procedure that should only


    be done as an inpatient procedure are NOT to be placed
    into Observation Status at any time during their stay.

    3. The following patient unit/diagnosis SHOULD NOT be placed in


    observation status:

    A. Special Care units (BICU, MICU, NICU, PICU, SICU)

    1
    Hospital Policy Manual
    Policy Number: 2.2
    Effective Date: 10/01/08

    B. Head injury with loss of consciousness and frequent


    monitoring of neurological and vital signs
    C. Suicide attempts
    D. Delirium tremors
    E. Respiratory isolation
    F. Patients scheduled for an invasive procedure that should
    only be done on an inpatient basis.

    5. Patients with the following obstetrical diagnoses may be registered


    as an observation Labor and Delivery patient (LDO). This list is not
    inclusive:

    A. Check for active labor


    B. Decreased fetal movement
    C. Abdominal trauma during pregnancy

    6. Patients receiving intravenous services that last overnight or longer


    should be admitted as an inpatient. Observation should not be
    billed concurrently with therapeutic services such as chemotherapy.

    GUIDELINES/GENERAL COMMENTS

    1. No observation registrations for patients requiring an acute level of


    care (those meeting the Hospital’s admission criteria).

    2. There must be a written order for observation status. In addition,


    the Admission Approval form must be checked off in the
    “Observation” box so the patient may be placed in observation
    status. Also, there must be documentation in the medical record
    addressing why the patient is in observation, and the treatment plan
    to be administered. All one-day stay admissions require review and
    approval of case manager prior to billing.

    3. If the patient’s stay is longer than 23 hours, the record must reflect
    the extenuating circumstances that caused the discharge delay.
    Any observation stay greater than 24 hours for reasons that do not
    meet the definition of “extenuating circumstances” shall be referred
    to the Utilization Review Committee.

    4. If at any point during observation status a patient meets acute level


    of care criteria, observation status must end immediately and the
    patient should be admitted.

    5. If the patient’s status is changed to inpatient, the physician must


    write a new set of admit orders, including date and time, and
    document the specific reason(s) for admission.

    2
    Hospital Policy Manual
    Policy Number: 2.2
    Effective Date: 10/01/08

    6. Patients admitted for observation receive care according to the


    same hospital standards, policies and procedures as inpatients.

    7. Observation is not to be used as a substitution for outpatient care.

    8. Patients on observation status must not be allowed to leave the


    hospital on pass.

    9. Observation beds status may not be used to place patients in


    house overnight, who are scheduled for inpatient surgery the next
    day, but have no place else to stay.

    10. All exclusions for reimbursement for Observation Status are based
    upon Centers for Medicare and Medicaid Services (CMS) and other
    third party payer guidelines.

    _______________________
    Administrator

    ____9/17/08_____________
    Date

    Approved by Clinical Board: 9/19/00, 12/17/02, 7/19/05, 9/16/08


    Written: 2/95
    Reviewed: 8/08
    Revised: 10/97, 8/00, 1/03, 6/05, 8/08

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