Patients who don't meet inpatient status

[smalltownNP]

Hi, I am a Nurse Practitioner, work as a Hospitalist, I had an 80 yr old F, hx of CHF, who came into the hospital, sent by her Cardiologist, with complaints of increased SOB on exertion and weight gain for the past 1 month. Patient did not qualify for inpatient status due to her labs and imaging, BNP 304. Patient was started on a lasix drip and did have a weight loss of 12 pounds, with resolution of SOB. Why wouldn't patient meet inpatient status?

[djmatte, ADN, MSN, RN, NP]

Hospital/insurance policies I'd imagine. If the patients symptoms were relieved by a lasix gtt, then there's no need to keep her.

Incidentally I was just at a conference that was advocating for lasix infusions being an arm of primary care to minimize trips to the ed when symptoms can be treated effectively out patient. If her cardiologist had something like this in site, she likely would have never been sent to the ed.

[brownbook]

Not your question, but are observation or short stay units available where your work? Seems like they would be appropriate in this situation.

[Dodongo, APRN, NP]

She couldn't have just been Obs?

[smalltownNP]

She was admitted under observation, I thought with her ongoing symptoms of SOB, and weight gain she would've met for Inpatient Status

[smalltownNP]

yes we do admit patients under observation.

[djmatte, ADN, MSN, RN, NP]

She was admitted under observation, I thought with her ongoing symptoms of SOB, and weight gain she would've met for Inpatient Status

I thought you said the SoA resolved and she dropped 12#s with the lasix drip? Once that's clear and without any other lab elevations, not sure the benefit of keeping her there.

[Corey Narry, MSN, RN, NP]

The first rule for in-patient admission criteria is whether the patient requires hospital stay spanning at least two midnights (or 3 days). In that period, that patient should exhibit symptoms, have an admission diagnosis, and a treatment plan that is medically necessary. You would think a patient requiring Lasix gtt would meet criteria but as another poster mentioned, there are out-patient protocols for Lasix infusion now. The fact that this patient did not have additional monitoring requirements (such as frequent lab draws and frequent repletion of Potassium maybe) made this case uncomplicated and must have been the reason for downgrade to Observation status.

[traumaRUs, MSN, APRN]

When I worked in the heart failure service - we gave IVP Lasix in the clinic and/or Lasix infusion in the infusion center - few people were admitted even for obs.