Observation Admits

[applesxoranges, BSN, RN]

How does your hospital deal with observation patients? Is there an observation unit? Are they sent to the floor like an inpatient?

if there is an obs unit, how is it managed? Is it managed similar to the floor? Does the emergency room manage it?

Which physicians manage it? Emergency, hospitalists, or primary care?

We we have an obs unit that is newer and does not seem to be functioning well. Supposedly how it is sort set up is common in all hospitals. However, the other hospits I've worked at send obs patients to the floors like inpatients.

There is is no set criteria beyond it is what the physician thinks to limit inappropriate patients being admitted to the obs unit (which is not staffed like a normal floor).

The max is 9 patients if there are 2 nurses. No techs. Nurses are responsible for admission profile, order reconcile, ekgs, blood draws, medications, activities of daily living, and everything but respiratory treatments. No assistant, clerk, lab tech, or whoever does ekgs.

[mmc51264, BSN, MSN, RN]

I work on an ortho unit and many of our shoulder and ankle revision/replacements (some of the toe amputations, too) are meant to onlt be there overnight 23 hours max. They are admitted to our unit as a regular pt, put have an obs status. They are included in our census, everything. If for some reason, they need to stay longer, their status can be changed to inpatient. We have same-day sx, and if a need arises there for admission, they are transported to us and either admitted obs or inpt

[Nola009]

They are admitted to the MS floor. Obs is on their chart/visit #.

[classicdame, MSN, EdD]

admitted to appropriate floor as obs and case managers make sure they either get discharged on time or admitted.

[workinmomRN2012, BSN]

I work on an Obs unit (clinical decision unit). We have a secretary during the day and most of the time on eves, we have a PCT unless the census is low- if so the PCT can get pulled to another floor. Our floor goes up to 16 with 3 nurses or 12 pts and 2 nurses. Sometimes we still get inappropriate patients on our floor through no fault of our own, we question the order and they still get sent to our floor. Lately we have had our share of MET calls on our unit. It can be very fast paced and patients don't usually stay more than 48hrs and if there aren't any beds available the pt status is changed to inpatient. This unit is an extension of the ED.

[workinmomRN2012, BSN]

We also have a book with protocols that need to be met before the patient can come to our floor, ex: if someone comes in with chest pain they need to have 2 negative troponins before they can come to our floor.

[applesxoranges, BSN, RN]

They threw the protocol book out. We were questioning whether a surgery patient was appropriate for the obs unit since most surgeries go to a specific floor after surgery and not obs. Nurses who normally worked the floor questioned it too. The doctor and ED charge basically said deal with it, you're getting the patient. If a physician writes for obs, then it is obviously safe for obs.

well, surgeon changed it to that unit on his or her own without us saying anything to him or her..So we didn't get the patient.

It it just doesn't seem like there are clear guidelines and it doesn't help that only one charge has worked in obs but they are expected to oversee it. It's not clear if it is ED or obs. Basically there are no set rules and anything can go. They also frequently say "the floors get six patients so they should handle four or five" forgetting that there is usually an aide, unit clerk that does strips and paperwork, and procedures like labs and ekgs are done by techs that adult obs does not use.

I guess im frustrated from what seems like a lack of appropriate leadership so I'm biased. I'm also mad I was accused of refusing patients I don't like when I callled him to tell the charge the patient not coming to us was showing up on our board. Inappropriate especially since I told him the surgeon wanted the patient to go to that unit first.

[~PedsRN~, BSN, RN]

I work in a Children's hospital so we may be set up a bit differently. We do have an observation floor which consists of a small amount of rooms and is staffed by two nurses at all times. Each inpatient floor has designated "obs" rooms as well. We like to keep this rooms as obs patients but in a pinch we can use them (and do often) as inpatient rooms. They are designed and look just like the other rooms on our floor.

[AJJKRN]

We have a strictly OBS unit that is across from our ED that takes only OBS patients, has designated floor nurses that can be floated to the regular floors but not to the ED and those nurses directly call the ED MDs for orders for those patients. We have another OBS unit that is a mix of over-flow inpatient and OBS that are separated by rooms as only OBS patients can be placed in certain rooms because of the different billing, etc. These nurses/patients use hospitalists, etc. Both floors have the same manager and staff are expected to be able to work both units or float to the Med-Surg floors when needed. Helpful by chance?

[applesxoranges, BSN, RN]

That would be more helpful than our current setup. We have floor staff that floats down but eventually ER staff is supposed to float to the obs unit but they are doing a poor job with it. They have about four dedicated obs staff and the rest was supposed to be ER staff by frequently the dedicated staff is floated to ER and floor staffs obs. The ER is over obs but it really is treated like the bastard stepchild. The ER physicians do not oversee obs patients but their primary care physician.

[wishiwereanurse, BSN, RN]

on ours the patients don't get to be obs unless the 'insurance' pays for it, otherwise you become inpatient regardless of your condition even if you will only be there for half a day...paperworks are same for both now

[applesxoranges, BSN, RN]

I feel bad for when people find out that obs is considered out patient. I had a couple the other day tell me that they couldn't be admitted obs and had to sign out AMA.