Background: Hospital Medicine is being increasingly involved in improving various metrices of inpatient care such as length of stay and cost of care. Patients who do not meet ‘inpatient criteria’ often contribute to significant financial costs to hospitals and remain in ‘observation status’ during their hospital stay. Observations units which were introduced by emergency doctors […]

Case Presentation: A 63‐year‐old man with diabetes complicated by peripheral neuropathy presented with increasing right lower‐extremity weakness and a recent fall 2 days prior to admission. His vital signs and physical exam were unremarkable with the exception of a 2 × 2 cm nontender, nonfluctuant stage 2 decubitus ulcer on his right gluteal fold. After […]

Case Presentation: The patient was a 24‐year‐old white woman with a history of rheumatoid arthritis diagnosed 1 year ago. She presented with symptoms of diffuse postprandial abdominal pain, nausea, and generalized fatigue for a few months. Her symptoms acutely worsened over the course of 3 days, with radiation of sharp abdominal pain to the chest, […]

Background: Observation status was designed to reduce health care costs for patients in need of short hospital stays. CMS suggests that observation care should typically require less than 24 hours, and only rarely last more than 48 hours. However, studies suggest that length of stay for observation patients is often longer than CMS guidance.[1,2] An […]

Background: Over the last 2 decades there has been increasing adoption of Observation (OBS) units across the healthcare facilities in United States. Health reforms like 2 midnight rule and 30 day readmission penalties, congestion in the ED, poor operational outcomes in OBS population mixed with inpatients (IP) etc. further added to the need for dedicated […]

Case Presentation: A 5‐month‐old female with worsening skin rash for 2 months was admitted for evaluation. The rash began as generalized flesh colored papules on the upper chest and antecubital fossae. Initially, the patient was treated with OTC moisturizing creams. However, the rash began to spread to include her face and abdomen. The color changed […]

Background: There is growing adoption of Observation units as an answer to increasing payment denials in short stay admissions (ranging from 24-72 hours), overcrowding in emergency room, need for inpatient capacity and mismatched resource utilization. There is quite a bit of variation in the type of OBS units like Level I OBS unit- which is […]

Case Presentation: This is a 66‐year‐old woman with no diagnoses of any pulmonary diseases or any occupational exposures but with ulcerative colitis diagnosed 9 months prior to admission for which she was started on sulfasalazine, who was admitted to the internal medicine service for fever of 39°C at home, nonproductive cough and dyspnea. Patient had […]