I've always been told (in SC, HI, and PA) that obs can go inpatient, but you cannot - full stop - go inpatient to obs. It just cannot be done.We initially dealt with it by letting the admitting doc decide. But there were too many that didn't know what they were doing. They were choosing "admission" because "we get paid more for an admission"... totally overlooking the fact that they get paid nothing if it doesn't meet admission criteria. It got so botched by the inpatient side, that it was left up to the discretion of the ED provider, since we were more independent of the financial side of the equation, and generally had a better gut of whether a patient was a more than or less than 2 midnights kind of case. We still discuss it with the admitting doc, but ultimately, the decision is ours. As a general rule, it's much easier to go from an Obs and make it an admission. It's very difficult to go the other way. So if someone is borderline, its easier to just Obs them and let case management figure out if it meets criteria once they are hospitalized.
I've always been told (in SC, HI, and PA) that obs can go inpatient, but you cannot - full stop - go inpatient to obs. It just cannot be done.
I've never understood why this is up to us. The simplest answer is to make everyone obs so that I don't get a "ding". The admitting doc can always change them later. Oh wait they didn't see the patient within 12 hours in enough time to change over to inpatient status? Not my fault....
Obviously any ICU patient, or patient undergoing a surgical procedure I make inpatient status.
We make overdoses that go to the ICU observation status. Appendicitis and I believe cholecystitis also start out as observation at our hospital. Certain fractures going to the OR also are observation status. It really doesn't make a whole lot of medical sense. I agree that we should have no input into this. I just want the patient to leave the ED once their emergent work-up/treatment is complete.
The OR pts, for us for dispo, are "OR/SPU" (Short Procedure Unit). I THINK, but am not sure, that, if the SPU folks need more time, they go inpatient.
Likewise, ipso facto, if a pt goes to ICU, they're inpatient. I suggested the angioedema pts as ICU-obs, and was roundly shot down. Finally, I was told that pts that need to be admitted for blood transfusion are inpatient.
I don't make the rules.