24 Hour Observation Unit & Charting

[Spatialized]

My unit is in the process of starting an observation unit. It will be detached from the ED, under our Internal Medicine service, catering to CP r/o MI, COPD, CHF, Cellulitis, Syncope and Pneumonia observation status patients. Obs is based around CMS guidelines regarding outpatient treatment, where the patient is a little too sick to go home, but not really sick enough to be admitted as an inpatient. Goal is a less than 24 hour stay, but CMS allows up to 48 hours of observation status.

A couple of questions for those out there dealing with this kind of unit.

1. Charting. According to our understanding of the CMS rules, we have to be "doing" something for the patient to be there, documented every hour. A good example to me is the patient who is waiting on cardiac enzymes to either rule out, or rule in. How/what do y'all chart about these patients during this time frame? Simple focused assessments and/or vitals every hour? Or some variation thereof?

2. Discharge. Is discharge protocol and nurse driven, or are the physicians still intimately involved?

3. Testing. Echos? Stress tests? Ultrasounds? How involved are y'all getting?

Any other information about what has/hasn't worked would be appreciated as well.

Thanks for reading and sharing!

Tom

[libbyjeanne]

Well, for our obs patients in Med surg, we basically do the same charting as we do for our inpatients; assessments, hourly room checks, Q 4 or 6 vitals (at the nurse's discretion). Discharge is the same procedure, but we have special discharge teaching we need to do for our CHF pts. I have seen all tests for pts also, including echos, stress tests, MRI/MRA/CT, lower and upper GIs. There are special billing papers we have to fill out at discharge because billing is different for obs and inpatient.

Sorry I dont have more ER oriented obs advice....only M/S.

[SummerGarden, BSN, MSN, RN]

my obs unit is run like the above poster's unit. we only needed vitals etc. every 4 hours. in fact, the only difference between my unit and the er is that we keep our patients for 24-48 hours, they are transferred to the floor rather then walk-ins, and the er has computerized charting. the only differences between the medical surgical units and this unit in my hospital is that the obs unit is treated like the er in priority so our patients receive diagnostic and lab testing over all other patients, less paper charting, and the patients are supposedly not so sick they need to be a full admit. i say supposedly because i have given blood, drips, and coded patients who were diagnosed as low acuity. good times!

anyway, i will be starting a new position in a trauma ed soon so it is nice to have had obs experience in my knowledge base. the pace on my obs unit was fast, but so is the pace on the tele step-down unit and medical surgical units i worked. gl!

[floatRN]

We have alot of observation status patients on the floor. We chart on them the same as we do on inpatients. Only difference is observation patients don't need a care plan.

[KJ2001]

Tom,

I am actually starting a similar unit. We are just at the beginning of planning. Please update me on how you are doing... or if you get any great resources. Good luck!

KJ