Starting observation reviews

cari.coker-fritsch@saukprairiehealthcare.orgcari.coker-fritsch@saukprairiehealthcare.org
in CDI Expansion
I am starting to review observation patients to see if I can find any opportunity to change them to inpatient.  I am wondering if anyone can offer any good resources on inpatient vs obs criteria?  I would like to have a baseline understanding of what is needed to qualify a patient for inpatient or obs.  I work at a small hospital, and am the only CDI RN.  Our care management dept is in flux now, and we don't have a UR nurse right now who I can ask about this.  Do you have a website or book you would recommend, so that I can understand the basics of utilization review and inpt status?  Thanks!

Cari

Comments

  • stayrookgt@gmail.comstayrookgt@gmail.com
    I work in a small hospital as well and I think you would need access to Interqual or Milliman criteria. This is what most payers use to determine inpatient vs observation. We use Interqual. Your facility should already be using some criteria. I would ask your Case Management team what criteria they use and get access to it. We used to use the book, but now it is all online.
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