| Description |
1 online resource (xxiii, 792 pages) : illustrations |
| Series |
Cambridge medicine |
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Cambridge medicine (Series)
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| Contents |
Cover -- Half-title -- Title page -- Copyright information -- Table of contents -- Advance Praise -- About the Editors -- Editor -- Section Editors -- List of Contributors -- Foreword: Onward and Upward -- Preface -- Part I Administration -- Chapter 1 Observation Medicine -- Key Concepts: How to Start (and Maintain) an Observation Unit: What You Need to Know: Clinical Issues -- Overview and Introduction -- What is Observation? -- Types of Observation Unit: Protocol Driven and Designated Unit -- Open and Closed Units -- Hybrid Units -- Length of Stay -- Location of the Observation Unit -- Staffing the Observation Unit -- Flexible Staffing -- Nursing Staffing Ratios in the Observation Unit -- Cross Coverage in the Observation Unit -- Nursing Staffing: Longevity and Patient Satisfaction -- Staffing the Unit: Physician -- Staffing the Unit: Advanced Practice Providers -- Staffing the Unit: Additional Personnel -- Administrative Staffing of the Observation Unit -- Design, Equipment, and Supplies for the Observation Unit -- Size of the Observational Unit -- Metrics, Benchmarks, Performance Improvement, and Patient Safety, Quality and Experience -- Benefits of an Observation Unit: Clinical and Financial -- Business Plan -- References -- Chapter 2 Observation Medicine -- Key Concepts: How to Start (and Maintain) an Observation Unit: What You Need to Know: Administrative Issues -- Overview -- References: Overview -- The Two-Midnight Rule -- References: Two-Midnight Rule -- Background -- What Is Observation? -- Simple versus Complex or Extended Observation -- Impact of the Two-Midnight Rule -- References: Background -- PEPPER Report -- What Is the PEPPER Report? -- What Is Contained in the PEPPER Report? -- How Can the PEPPER Report Be Used? -- How Can One Access the PEPPER Report? -- What Can Happen if There Are Errors in Payment? |
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Revision of the PEPPER Report Based on the Two-Midnight Rule -- References: PEPPER Report -- Criteria for Inpatient Admission or Observation -- Overview -- Medical Necessity Screening Tools -- Changes in Observation Status: From Inpatient to Observation -- Changes in Observation Status: From Observation to Inpatient Admission -- References: Criteria for Inpatient Admission or Observation -- Inpatient Prospective Payment System (IPPS) -- What Is IPPS? -- Inpatient Hospital Stays, IPPS, Targeting Short Inpatient Stays, Reimbursement and Observation -- References: Inpatient Prospective Payment System (IPPS) -- Medicare's Hospital Payment Monitoring Program (HPMP) -- References: Medicare's Hospital Payment Monitoring Program (HPMP) -- Observation Medicine Billing: The Controversy -- References: Observation Medicine Billing: The Controversy -- Summary -- Glossary of Terms -- Chapter 3 Observation Medicine Development Over Time -- Observation Medicine Concept: Improved Delineation of Appropriate Level of Care -- Development of Leadership -- Evolution of Observation Unit Staff -- Creation of Functional Physical Plants -- Development of Best Practice Operations -- Development of Financial Viability -- References -- Chapter 4 Observation Medicine Principles -- Observation Is the Correct Level of Care -- Hospital Site of Service -- Acute Care Staffing -- Continuing Care in Outpatient Setting -- Intensive Managerial Review -- Economical Service -- References -- Chapter 5 Design -- References -- Chapter 6 Staffing Considerations -- Leadership -- Nurses -- Physicians -- Advanced Practice Providers -- Ancillary Staff and Consultants -- References -- Chapter 7 Nursing -- Observation Unit Location: To Cohort or Not Cohort Observation Unit Patients -- Observation Unit Staffing -- Observation Unit Design, Equipment, Supplies |
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Observation Unit Census: ''Time Lag before the Observation Unit Is Consistently Full'' -- Observation Unit Staffing: Staffing for the Daily and Hourly Census in the Observation Unit -- Assigning Observation Unit Nursing and Other Personnel to Other Areas and ''Pulling Observation Unit Staff/Personnel'' -- Administration of the Observation Unit: Physician Medical Director of the Observation Unit -- Administration of the Observation Unit: Nurse Manager of the Observation Unit -- Summary -- References -- Chapter 8 Risk Management -- Introduction -- What Is Risk Management? -- Who Has the Real Risk? -- The Quality of Risk Management Data -- System Thinking -- Improved Communications -- Improved Cost-Effectiveness -- Legal Issues -- High-Risk Situations -- Conclusion -- References -- Chapter 9 Metrics and Performance Improvement: Patient Quality, Safety, and Experience -- Introduction -- The Importance of Observation Medicine -- Components of a CQI Program -- Observation Unit Database -- Documentation for the Observation Unit -- Metrics for the Observation Unit -- Length of Stay Metrics -- Long Length of Stay (Greater than 24 Hours) -- Short Length of Stay (Less than 8 Hours) -- Metrics Similar to Emergency Department Metrics -- Complaints -- Acuity Metrics -- Types of Indicators for the Observation Unit -- Structural Indicators -- Process Indicators -- Outcome Indicators -- Rate-Based Indicators -- Sentinel-Event Indicators -- Benchmarks -- Protocols, Clinical Pathways, and Standardized Order Sets -- Observation Unit or Clinical Decision Unit Meetings -- Summary -- Appendix 9.1: Observation Unit Patient Log -- References -- Part II Observation Medicine: Clinical Setting and Education -- Chapter 10 The Community Hospital Perspective in a Suburban/Rural Setting -- Pediatric Observation in the Community Setting -- References |
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Chapter 11 The Urban Community Hospital -- References -- Chapter 12 The Tertiary Care Hospital and Academic Setting -- References -- Chapter 13 Observation Medicine and the Hospitalist -- References -- Chapter 14 Training and Education -- Residents -- References -- Chapter 15 Training and Education -- Medical Students/Fellows -- References -- Part III New Developments in Observation Medicine -- Chapter 16 Extended and Complex Observation -- Background -- Pathophysiology -- Inclusion criteria -- Exclusion Criteria -- Management/Intervention -- Summary -- References -- Chapter 17 Extended Observation Services -- References -- Chapter 18 Hospital Readmissions -- Overview -- Rates of 30-Day Readmissions -- Should 30-Day Readmissions Be Used as a Metric? -- International Perspective -- Report to Congress -- Patient Disease/Illness/Injury Factors -- Demographic Variables -- Individual Factors -- Socioeconomic Factors -- Access to Care, Health Care Utilization and Community Factors -- Hospital Factors -- Potential Solutions -- Potential Solutions: Observation Medicine -- Summary -- References -- Chapter 19 Level of Care Determination: Medical Necessity Risk Stratification -- Threshold to Observe: Missed Diagnosis Rate -- Threshold for Inpatient Admission: Observation Usage Rate -- The Utilization Review Process -- Risk Stratification -- References -- Chapter 20 Accountable Care Organizations -- Introduction -- Accountable Care Organizations Aim to Disrupt the Health Care Industry -- So What Exactly is an ACO? -- What the First ACOs Look Like -- ACOs are Poised to Fuel Growth of Observation Medicine -- Observation Units Become Crucial Components of ACO Strategy -- Chapter 21 Acute Medicine in the United Kingdom -- Overview -- Outcome -- Conclusion -- References -- Part IV Clinical -- Subpart IVA Clinical -- Cardiac -- Chapter 22 Chest Pain -- Background |
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Pathophysiology -- Risk Stratification -- Risk Scores -- Criteria for the Observation Unit -- Inclusion Criteria -- Exclusion Criteria -- Observation Unit Evaluation -- Serial Electrocardiogram (ECG) -- Cardiac Markers -- Troponin, CK-MB, and Myoglobin -- Provocative Stress Test and/or Imaging -- Immediate Management of Newly Confirmed ACS in the OU -- Disposition -- Chest Pain Center Quality Improvement -- Summary -- References -- Chapter 23 Heart Failure -- Introduction -- Presentation of HF in the Emergency Setting -- Diagnosis of ADHF -- History and Physical Examination -- Radiographic Findings and Biomarkers -- Noninvasive Bioimpedance Technology -- The Initial Treatment Goal in ED -- The Observation Unit in the Emergency Setting -- OU Entry Criteria -- OU Exclusion Criteria -- Appropriate OU Therapy -- Pharmalogical Therapy -- Diuretics -- ACE Inhibitor -- Ejection Fraction -- Criteria for Hospital Admission from the OU -- Criteria for Discharge -- Discharge Instruction and Patient Education -- References -- Chapter 24 Atrial Fibrillation -- Background -- Pathophysiology/Electrophysiology -- Management of AF -- Inclusion/ Exclusion Criteria -- Observation Interventions -- Conclusion -- References -- Chapter 25 Syncope -- Introduction -- Pathophysiology -- Discussion -- Patient Criteria -- Patient Selection -- Inclusion -- Patient Selection -- Exclusion -- Management -- Echocardiography -- Graded Exercise Testing -- Electrocardiographic Monitoring -- Tilt-Table Testing -- Electrophysiology -- Computed Tomography -- Outcome -- Conclusion -- References -- Chapter 26 Stress Testing -- Introduction -- Discussion -- Pretest Probability -- Pharmacologic Stress Agents -- Types of Stress Tests -- Testing in Women -- Patient Characteristics -- Management -- Outcome -- Conclusion -- References -- Subpart IVB Clinical -- Respiratory -- Chapter 27 Asthma |
| Summary |
"Using sample administrative and clinical protocols that any hospital can use, this book gives a detailed account of how to set up and run an observation unit and reviews all medical conditions in which observation medicine may be beneficial. In addition to clinical topics such as improving patient outcomes and avoiding readmissions, it also includes practical topics such as design, staffing, and daily operations; fiscal aspects, such as coding, billing, and reimbursement; regulatory concerns, such as aligning case management and utilization review with observation; nursing considerations; and more. The future of observation medicine, and how it can help solve the healthcare crisis from costs to access, is also discussed. Although based on US practices, this book is also applicable to an international audience, and contains instructions for implementing observation in any setting or locale and in any type of hospital or other appropriate facility"--Publisher's description |
| Bibliography |
Includes bibliographical references and index |
| Subject |
Hospitals -- Observation units.
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Hospitals -- Emergency services.
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Hospitals -- Admission and discharge.
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Emergency Service, Hospital
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Diagnostic Techniques and Procedures
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Emergency Medicine -- methods
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Watchful Waiting -- methods
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Patient Admission
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Patient Discharge
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emergency rooms.
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Hospitals -- Emergency services
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Hospitals -- Admission and discharge
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Hospitals -- Observation units
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| Form |
Electronic book
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| Author |
Mace, Sharon E., editor
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| ISBN |
9781139136365 |
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1139136364 |
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