Background: Hospital reimbursement for medical necessity is based on the level of care a patient is receiving. In the electronic medical record (EMR), the level of care, inpatient or observation, is determined by a practitioner order or physician certification. The timeliness of this order is of utmost importance, as medical necessity is a dynamic status. [...]

Background: Kidney injury significantly reduces renal clearance, posing unique challenges for patients with type II diabetes, particularly those on insulin. This reduced clearance can lead to elevated insulin levels, increasing the risk of hypoglycemia and subsequent complications, which often extend the patient’s length of stay (LOS). Chronic kidney disease (CKD) itself is an independent risk [...]

Background: At the time of hospitalization, a physician must place an admission status order designating inpatient, outpatient, or observation care. If a patient requires medically necessary hospital care for at least 2 midnights, an inpatient admission order is appropriate. If care is expected to last fewer than 2 midnights or if there is uncertainty about [...]

Background: Insurance companies are issuing more denials and causing financial instability for hospitals. On average, hospitals are paid $6,000 less for a patient in outpatient observation status as compared to inpatient status. According to Kaiser Family Foundation Health, the average expense in 2022 for a hospital per inpatient day was $3,025 and is only increasing. [...]

Case Presentation: We present a 25-year-old female with past medical history of right fibular hemimelia who presented with acute on chronic leg pain. She had a history of multiple prior limb lengthening surgeries complicated by Staphylococcus aureus infection with hardware removal. Patient endorsed weeks of worsening leg pain and cramping. Had been seen by orthopedic [...]