extended stay patients

Nurses General Nursing

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Hi, I joined this forum years ago when i was a student but havent been on the site in a while. so, i had to make a new user name. anyways, I work in a large city hospital as a PACU nurse.

Over the past few months my hospital has turned the PACU into an extended stay unit. as i am told, insurance companies arent paying for certain surgeries that they did before. when a doctor wants a patient admitted after this type of surgery, if they dont meet these ridiculous guidelines they are to stay the night in pacu as "extended stay"

i kinda understand some of this, but just want to know if any other hospitals are experiencing the same thing. My coworkers often say this is a direct result of the health care reform bill, but to be honest i havent followed that to well, but i can see how it makes sense/

finally, i just want to know if any other nurses out there have any knowledge of this or any type of direct issue resulting from the health care reform bill?????

thanks in advance :)

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

Our outpatients and extended stay have the same status. We have an area that is more conducive to overnight stay--no extra cost--same exact type of care.

The difference is that we are a procedural area and are open 24/7 for emergency surgeries. We don't have "time" for the nicey-ties of having a room, etc.,

The lights are on--it's noisy, and you're meant to wake up....so to make the patients more comfortable, they go to an overnight floor.

It makes a lot of sense and patients are much happier to recover in a quiet area.

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thanks for your response! what happens at your work seems the same as mine. outpatients and extended stay i think are billed differently for us. in our pt navigation system they tag the extended stay a certain color. whats is strange is at the end of the night if there are open hospital beds, admissions has to assign a bed to these same pts we are told insurance doesnt pay for. i really dont get it

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My workplace has a "Short Stay Unit." It's a max 24 hr stay (although some insurance will go to 48hrs), billed at a per hr of stay rate (would cost the same as a regular room if the pt stayed the full 24 hrs). Most of the pts seem to be r/o chest pains, they stay until cleared by cardiac enzymes and stress test or admitted as a regular pt. Other pts are post ops that would generally have been discharged; but, these ones have some sort of issue--uncontrolled nausea, need for IV fluids, uncontrolled pain, not waking up well enough, etc. Pt's may or may not be on telemetry. Lots of insurance/regulatory hoops to jump through. It's a busy place, nurse pt ratio is 1:4-5, with an assistant for every 10 pts.

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Specializes in pulm/cardiology pcu, surgical onc.

We call these 23 hr admits. If they were originally in short stay (after PACU) and expected to go home the same day but for whatever reason were unsafe to do (ie nausea, unable to void, uncontrolled pain) then they would be admitted to a regular bed on the floor. But they would need to discharge within the 23 hrs of original admission or the doc would have to provide rationale for keeping them longer and than they would be made an inpatient.

ETA: another smaller hospital I work in has opened an observation unit for ED admits that are r/o chest pain, dehydration, etc to help free up ED beds and staff. They are considered like a 23 hr admit usually discharging within the day and not requiring the same charting but a very busy unit nonetheless.

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I have dealt with 23 hr patients since around 1996ish. So it has nothing to do with health care reform. I have kind of made it a point to not know too much about any patient's insurance coverage, medi-cal, medi-care, stuff.

My current unit has two over night, 23 hour, private rooms so the patients have a nice quiet area to stay. These are post-op patients the surgeon did not want to go home the same day of surgery. We are notified several days ahead of time of the surgeon's plans so our over night nurses can be scheduled to come into work.

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I have dealt with 23 hr patients since around 1996ish. So it has nothing to do with health care reform. I have kind of made it a point to not know too much about any patient's insurance coverage, medi-cal, medi-care, stuff.

My current unit has two over night, 23 hour, private rooms so the patients have a nice quiet area to stay. These are post-op patients the surgeon did not want to go home the same day of surgery. We are notified several days ahead of time of the surgeon's plans so our over night nurses can be scheduled to come into work.

You are right, sort stay has been in existence for about twenty years. I was admitted to such a unit, 1997, following a three level cervical lami,with plates and grafts. I was shocked at the charge to my insurance more then $850 an hour. But you are quite correct, short or extended stay has nothing to do with the health care reform bill. During the 1990's I had several surgeries where I was held for short stay. My SIL recent had a lami and was admitted to the ortho floor for forty-eight hours.

PACU is really not a good place for short stay patients. They need quiet.

GrannyRN65

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Specializes in ICU, Telemetry.

I was getting these kind of patients 3 years ago, so I don't think it has anything to do with current legislation. The insurance companies run hospitals now...

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You are right, sort stay has been in existence for about twenty years. I was admitted to such a unit, 1997, following a three level cervical lami,with plates and grafts. I was shocked at the charge to my insurance more then $850 an hour. But you are quite correct, short or extended stay has nothing to do with the health care reform bill. During the 1990's I had several surgeries where I was held for short stay. My SIL recent had a lami and was admitted to the ortho floor for forty-eight hours.

PACU is really not a good place for short stay patients. They need quiet.

GrannyRN65

thanks! I have only been a nurse for almost 3 years so just about everything is new to me. Our extended stay patients are sometimes referred to as 23hr admits too, but then we have 23hr admits that get physical beds(room) and extended stay pts that dont.

I once had a patient who had had a percutaneous nephr tube placed. she had already had one side done, so post op she had 2 PCN tubes, a foley and a stent. she needed post op labs, ekg, and all types of things and admissions would not give her a bed until a dr finally called and said they were admitting her for "tachycardia"

I dont want to say i am relieved that this isnt due to the reform, but i got tired of my coworkers saying thats the reason without being able to back it up. I just want to understand where all these changes are coming from. I hate having to try and explain to a pt that "your insurance wont pay for a hospital room, but will pay for you to sleep in an open 24hr PACU"

thanks everyone!

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I was getting these kind of patients 3 years ago, so I don't think it has anything to do with current legislation. The insurance companies run hospitals now...

is this new, the insurance companies running the hospitals? or has it always been this way... in some form?

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Specializes in Med/Surg/Tele/Onc.

Insurance companies have been running hospitals and Dr's practices for 20 years at least.

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