Observation Unit. Romil Chadha
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1 Observation Unit Romil Chadha
2 Observation vs Inpatient Whenever in doubt please call to get assistance from Utilization Review (UR) Randy A. Rosen, MD, reviews cases and usually s about patients who do not qualify for inpatient. Physician Advisor, Utilization Review UK Healthcare Cell phone:
3 Closed Observation Unit It was planned as a closed unit and only 5 services were supposed to admit here Blue Surgery (Trauma Surgery) Cardiology Emergency Medicine Hospital Medicine Neurology With increasing ED volumes; we are using it for ED patients, boarders and observation patients Further presentation is pertinent to only Hospital Medicine
4 MT-8 We assign all Observation patients from Emergency Department to MT-8 Average observation patients are 3-4 each day If patient is admitted they will stay under the care of the same team MT-8 and same attending
5 Clinician Coverage Observation Unit, Team MT-8 7am-6pm 6pm-10:30pm 10:30pm-7am MT-8 Attending Swing-1 Attending Night-1 Attending
6 Inclusion Criteria Patient does not meet any criteria for an admission Expected length of stay less than two midnights Patients presenting to Emergency Department
7 Common Observation Diagnosis Syncope Chest Pain Abdominal Pain Nausea/Vomiting/Diarrhea Dehydration Acute Kidney Injury
8 Observation Unit Diagnoses Abdominal Pain Allergic Reaction Active bleeding or post procedure (EGD in Emergency Room), hemodynamically stable Asthma exacerbations, mild-moderate exacerbation Cellulitis, goal for completion of outpatient antibiotics COPD, mild exacerbation COPD, without exacerbation with new indication for home oxygen DVT or PE, goal for outpatient bridging Dehydration Esophageal Foreign-body, post removal Gastroenteritis
9 Observation Unit Diagnoses Hepatic Encephalopathy Hypoglycemia without persistent coma Hyperglycemia without DKA or HHS Intoxication, cooperative patients Pneumonia community acquired, goal for completion of outpatient antibiotics Pyelonephritis, urine tract infection, goal for completion of outpatient antibiotics Symptomatic anemia (to reverse symptoms with blood transfusion) Syncope Uncontrolled hypertension, not requiring drips or intra-arterial pressure recordings
10 Exclusion Criteria Expected length of stay more than two midnights Progressive Care patients Actively dying hospice patients Acute abdomen Altered mental status, except Hepatic Encephalopathy Blood pressure control requiring intra-arterial pressure recordings Chest pain with ongoing ischemic pain Critical care needs (Patients who are intubated or on pressors) Diabetic ketoacidosis or hyperosmolar hyperglycemic state Hemodynamic instability
11 Exclusion Criteria Impending airway compromise Intoxication or withdrawal patients who are uncooperative Major Trauma patients Obstetric patients Pediatric patients (age less than 18 for non-emancipated or 16 for emancipated) Psychiatry patients Restraints Status epileptics Sickle cell crises Transfusion of chemotherapeutic agent (Due to insurance needs)
12 Observation Orders Please use the same Admit Adult order from SCM & pick one of the following from the options Level of Care (Pick one) ED Observation (This one if Floor level) ED Observation Telemetry Patient Type (Pick this) ED Observation Anticipated LOS (Pick this) < or equal to 1 midnight
13 How to place orders? You need Pick to be very careful about orders One If you do not put right orders; patients Pick do not This go to Observation Unit Pick This
14 Observation Order Sets You can use some of Observation Order Sets
15 Admit Orders: When Observation is changed to Admit Please Discontinue/Reorder the same Admit Adult order from SCM & pick one of the following from the options Level of Care Floor/Acute Care Telemetry Progressive Care Patient Type Inpatient Anticipated LOS > or equal to 2 midnight ** You will also need a Bed Request Order to notify Capacity Command Center that your observation patient needs inpatient bed. **
16 If you have entered Admit Orders for Observation Patient? Discontinue/Reorder the same Admit Adult order from SCM & place Observation Orders Call ED Charge Nurse to transfer patient to Observation Unit
17 Ordering Home Medications Order Pharm Consult (Pharmacists to Dose Consult, Pharmacy Consult) Please specify Patient may take following home medications Please do not write Continue All Home Meds
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