Observation

pfowlerpfowler
edited May 2016 in CDI Talk Archive
Does anyone not have observation patients at your facility? If so, do
you review the charts? If you don't have observation patients how is it
avoided? We are looking at trying to eliminate OBS.. I am trying to get
some ideas on how to deal with this from CDI perspective. Any help would
be appreciated.



Patsy Fowler RN, MSN, CCDS
Certified Clinical Documentation Specialist
Marion Regional Hospital
PO Box 1150
Marion, SC 29571
Office 843-431-2044
Cell 843-431-2863
Fax 843-431-2432

Comments

  • gail_marinigail_marini
    edited May 2016
    We do review our observation patients because many times they end up as in
    patient.

    Gail Marini MM, RN, CCS
    Manager Clinical Documentation (CDI)
    Finance Department
    781-624-8413 (4:30am - 1pm)
    B- 7757
  • dvitalone1dvitalone1
    edited May 2016
    We don't here. We review them only when they turn to inpatient. Seems like a waste of time reviewing charts if there is no need
  • cynthia.a.goeweycynthia.a.goewey
    edited May 2016
    We do not review our observation patients until they become ipi.
    Cindy
  • robert.hodges2robert.hodges2
    edited May 2016
    From my former life in case management/utilization review and having
    been involved in a project at my former hospital from the state QIO to
    reduce inappropriate one day inpatient stays, and even thinking of the
    RAC's focus on one day inpatient stays I don't see how you can possibly
    eliminate the observation status. Since Observation is that "discovery
    period" when a patient presents with symptoms and is too sick to be
    released from care. It's a time frame to either stabilize and release
    the patient or make a determination that inpatient care is needed. Most
    chest pain admissions do not need inpatient care. Only those who have
    an acute cardiac event or other serious cause ruled in should be
    admitted.



    In my opinion, unless you plan to keep patients in your emergency
    department for over 24 hours or admit all of them and run the
    significant risk of a lot of payer denials I just don't see how
    observation status can be eliminated.


    Robert


    Robert S. Hodges, BSN, MSN, RN, CCDS
    Clinical Documentation Improvement Specialist
    Aleda E. Lutz VAMC
    Mail Code 136
    1500 Weiss Street
    Saginaw MI 48602
    P: 989-497-2500 x13101
    F: 989-321-4912
    E: Robert.Hodges2@va.gov


    "The difference between the right word and the almost right word is the
    difference between lightning and the lightning bug." Samuel "Mark Twain"
    Clemens
  • dbutlerdbutler
    edited May 2016
    Very well said -- I was thinking along those lines but was side tracked (besides, wouldn't have been able to say as well)

    Don
  • dbutlerdbutler
    edited May 2016
    We do review obs patients -- primarily because they can be changed to
    inpatient and we may not be able to catch them at that point prior to
    discharge. Extra work in some cases, but avoids missing others. On
    balance, worth it for us. Also by reviewing, have a better sense of
    those patients that are more likely to convert. There is the flip side
    -- inpatients that are converted to obs prior to discharge.

    With a good electronic ADT feed, your electronic work process can
    easily be designed with 'rules' to show or not show obs pts, and then
    add them in to the work process if they are converted to inpt -- can
    either catch concurrently or immediately after discharge while still
    'fresh' to the provider. Have an effective & robust software support
    can make such a difference!!

    If you have any component (direct or supportive) in the medical
    necessity process -- of course you must review.

    Finally, if the focus of CDI is as quoted below, shouldn't obs pts be
    reviewed anyway?
    (and yes, as my comments above indicate, we're not fully there
    either--keep pushing forward & making progress)

    "The focus of most CDI programs is on improving the quality of clinical
    documentation regardless of its impact on revenue. Arguably, the most
    vital role of a CDI program is facilitating an accurate representation
    of healthcare services through complete and accurate reporting of
    diagnoses and procedures."
    "Improving the accuracy of clinical documentation can reduce compliance
    risks, minimize a healthcare facility’s vulnerability during external
    audits, and provide insight into legal quality of care issues. "
    "The CDI professional works to facilitate the overall quality and
    completeness of clinical documentation to accurately represent the
    severity, acuity, and risk of mortality profile of the patient being
    treated."
    FROM: AHIMA Guidance for Clinical Documentation Improvement Programs

    Don
  • paxnerospaxneros
    edited May 2016
    As CDS we do not review obsv until they become inpatient. But we only focus on MCare patients and there are not that many admitted to my floors. 
  • catladyrncatladyrn
    We do not review observation pts. Our current software and our current corporate directive is heavily geared toward reimbursement :(

    ...and observation pts cannot be made to fit into that matrix. For the same reason, we do not review non-case-rate/DRG payors.
  • dallend@einstein.edudallend@einstein.edu
    edited May 2016
    We do have OBS at our facility. They do not appear on our census - we only have inpt show up on our census. If a pt. is dropped to OBS or SPU - There is a sticker on the chart and we do not review that case.
    We have some patients who fall through the cracks - we just chalk it up to experience.
  • digardskdigardsk
    edited May 2016
    I understood Patsy to mean eliminating obs from their workload, not eliminating the recognized status of obs...taking the rogue view of "not in our house"!

    Observation (or any outpatient status in a bed) shows on our worklist with an outpatient designation. We then take a peek at the observation/outpatient cases in case they go inpatient, or in case there is an obvious opportunity, but do not routinely put them in our software. They usually move too quickly to get to the physician in time!

    There is the flip side of when our "inpatients" already worked up and in our software convert to obs. In that case we change the financial class in our software and follow them through to discharge.

    This seems to work OK, although the communication with case management is not great. We don't usually know when they are changing the status...although we always tell them when we see an obs order for someone identified as IP

    Kim

    Kim Digardi, RN
    Clinical Documentation Specialist
    St. Helena Hospital
Sign In or Register to comment.