Last night a 68-year old male presented to the Emergency Department with chest pain. His pain lasted 45 minutes and resolved with 2 nitroglycerin tablets. He has history of coronary artery disease, stents placed within the past 2 years and a previous myocardial infarction. He has hypertension and diabetes. He was pain free by the time he arrived to the ED and hemodynamically stable.
We had a discussion with him regarding his risk, goals and preferences and decided for admit for acute coronary syndrome rule out. Our ED observation unit is full, so we admit him to the Cardiology floor for “observation” and continue acute coronary syndrome rule out with serial troponins and possible stress test vs. angiogram.
We signed out the patient to the cardiology floor. Then the patient refused to stay.
"I cannot stay if is observation, please admit me as an inpatient instead. I already have too many bills to pay.”
What do we know of observation status and inpatient admission? Is the care provided the same? Why do we need to know as providers?
In an effort to reduce short- stay admissions, many institutions are admitting patients under “observation” status. Patients admitted for observation care are considered outpatients despite that observation care can be provided in a regular hospital floor bed or in a specific area of the ED (ED observation units).
In the study “Observation or inpatient: Impact of patient disposition on outcomes and utilization among emergency department patients with chest pain” we collaborated with OptumLabs and AARP and using administrative claims data we compared a cohort of patient presenting with chest pain and admitted for “observation” versus “short-inpatient stay”.
Objectives and methods
What we found?
We concluded that:
The full article is available in Academic Emergency Medicine:
Why we need to know?
To comply with Medicare, Medicaid, managed care plans and commercial payer regulations related to observation or inpatient status. The determination of whether the hospital stay is designated as inpatient or observation should not affect the quality of care; however, it has billing and discharge planning implications.
Observation versus inpatient makes a difference for the amount of out of pocket cost for patients. This is particularly important for patients on Medicare, and it is critical for patients that will be placed on a skilled nursing facility after the hospital stay.
This article was first published on the Mayo Clinic Emergency Medicine Blog (EMblog), by M. Fernanda Bellolio, M.D. (@mfbellolio), an emergency medicine physician, and Kern Health Care Delivery Scholar alumna.