Background: Patients with undifferentiated but stable clinical presentations may manifest sepsis “time zero” (T-0) or the onset of sepsis-defining conditions while undergoing further evaluation in observation units (OUs). Since these units are often designed to facilitate diagnostic and clinical risk assessments, we hypothesize that patients experiencing T-0 while in OUs will likely experience similar or [...]

Background: The number of hospitals with dedicated observation units has grown in recent years to one-third of all United States hospitals and 80% of academic medical centers, though much is still unknown about how to best deliver care in this setting. At our institution, syncope is among the most common indications for admission to the [...]

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 [...]

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: Observation units were initially intended to function as a short stay unit for lower acuity patients with specific diagnoses, however this traditional model is currently evolving.  Rising health care costs and changing health care policy have resulted in an increase utilization of the observation unit and an expansion of diagnostic criteria to include more [...]

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 [...]

Background: Some patients lack the functional capability or social support to perform their own colonoscopy bowel preparation. These patients may be admitted to Inpatient units for support with the bowel preparation, but this process can be costly, lead to long lengths of stay, and decrease the admitting capacity of the hospital. An observation unit may [...]

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 [...]

Background: Observation Units (OUs) are a common healthcare delivery model for health systems across the United States. OUs vary from a type 1 to type 4 based on several factors[1]. Another category of OUs – second-level OUs – does not fit this traditional classification due to a different patient population composition and staffing model. The [...]

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 [...]