Indications:
(1) A medical condition expected to rapidly respond to treatment, possibly eliminating the need for an inpatient admission, with the treatment needed for more than 6 hours.
(2) The occurrence of an unexpected reaction or complication during or following an outpatient procedure, resulting in the need for monitoring or treatment beyond that usually provided in the immediate recovery period. This might include difficulty in awakening from anesthesia or a drug reaction.
(3) The need for a diagnostic evaluation that can be completed in 24 hours which is to be used to determine whether to admit the patient as an inpatient or to treat as an outpatient.
(4) The need to observe a patient for a possible serious delayed reaction to a treatment or a complication to traumatic injury.
Contraindications:
(1) use solely for the convenience of the patient, physician or family
(2) scheduled use, including standing orders for observation following outpatient surgery
(3) when it is expected at the time of admission that the patient will need to remain in the hospital for 24 hours or more
(4) use for blood product administration
(5) use solely to allow for placement in a long-term care facility
(6) routine preparation for outpatient procedure
(7) use solely for social factors, such as transportation problems, inability to perform activities of daily living, or homelessness
(8) use for diagnostic workup in patients who do not need skilled support or observation services
Requirements:
(1) A clearly written order by the physician.
(2) No more than one overnight stay. If additional hospitalization is needed, the patient is to be admitted as an inpatient.
(3) Documentation of the condition, a history and physical, diagnostic testing performed, treatment provided and response to treatment.
(4) A tally of the number of hours kept in observation, starting from when the patient is actually placed in the observation bed.
