Observation Medicine PDF
Preview Observation Medicine
Cambridge University Press 978-1-107-02234-8 — Observation Medicine Edited by Sharon E. Mace Frontmatter More Information Observation Medicine Usingsample clinical protocols, order sets, and administrative policies that anyhospitalcanuse,thisbookgivesadetailedaccountofhowtosetupand runanobservationunit(OU)andreviewsconditionsinwhichobservational medicine (OM)may be beneficial. In addition toclinical topics suchas improving patientoutcomes and avoiding readmissions, italsoincludes practical topics such as design,staffing,anddailyoperations; fiscal aspects such as coding, billing,and reimbursement; regulatory concernssuchas aligning case managementand utilization review with observation; nursing considerations; and more. The future of OM, and how OM can help solve the healthcare crisis from costs to access, is also discussed. Althoughbased on U.S. practices,this book is alsoapplicable to an international audience, and contains instructions for implementing observation in any setting or locale and in any type of hospitalor other appropriate facility. SharonE.MaceisProfessorofMedicineattheClevelandClinicLernerCollegeof MedicineofCaseWesternReserveUniversity;DirectorofObservationUnit,Director ofResearch,andpreviouslyDirectorofPediatricEducation/QualityImprovementat theEmergencyServicesInstitute,ClevelandClinic;andamemberoftheFacultyof MetroHealthMedicalCenter/ClevelandClinicEmergencyMedicineResidencyin Cleveland,Ohio. © in this web service Cambridge University Press www.cambridge.org Cambridge University Press 978-1-107-02234-8 — Observation Medicine Edited by Sharon E. Mace Frontmatter More Information Observation Medicine Principles and Protocols Edited by Sharon E. Mace EmergencyServicesInstitute,ClevelandClinic,Cleveland,OH © in this web service Cambridge University Press www.cambridge.org Cambridge University Press 978-1-107-02234-8 — Observation Medicine Edited by Sharon E. Mace Frontmatter More Information UniversityPrintingHouse,CambridgeCB28BS,United Kingdom OneLibertyPlaza,20thFloor,NewYork,NY10006,USA 477WilliamstownRoad,PortMelbourne,VIC3207, Australia 4843/24,2ndFloor,AnsariRoad,Daryaganj,Delhi– 110002,India 79AnsonRoad,#06-04/06,Singapore079906 CambridgeUniversityPressispartoftheUniversityof Cambridge. ItfurtherstheUniversity’smissionbydisseminating knowledgeinthepursuitofeducation,learning,and researchatthehighestinternationallevelsofexcellence. www.cambridge.org Informationonthistitle:www.cambridge.org/ 9781107022348 ©CambridgeUniversityPress2017 Thispublicationisincopyright.Subjecttostatutory exceptionandtotheprovisionsofrelevantcollective licensingagreements,noreproductionofanypartmay takeplacewithoutthewrittenpermissionofCambridge UniversityPress. Firstpublished2017 PrintedintheUnitedKingdombyClays,StIvesplc Acatalogrecordforthispublicationisavailablefromthe BritishLibrary. LibraryofCongressCataloginginPublicationData Names:Mace,SharonE.,editor. Title:Observationmedicine:principlesandprotocols/ editedbySharonE.Mace. Othertitles:Observationmedicine(Mace) Description:Cambridge,UnitedKingdom;NewYork: CambridgeUniversityPress,2016.|Includes bibliographicalreferencesandindex. Identifiers:LCCN2015048881|ISBN9781107022348 (Hardback:alk.paper) Subjects:|MESH:EmergencyService,Hospital| DiagnosticTechniquesandProcedures|Emergency Medicine–methods|WatchfulWaiting–methods|Patient Admission Classification:LCCRT48|NLMWX215|DDC616.07/5– dc23LCrecordavailableathttp://lccn.loc.gov/2015048881 ISBN978-1-107-02234-8Hardback ............................................................. CambridgeUniversityPresshasnoresponsibilityforthe persistenceoraccuracyofURLsforexternalorthird-party InternetWebsitesreferredtointhispublicationanddoes notguaranteethatanycontentonsuchWebsitesis,orwill remain,accurateorappropriate. © in this web service Cambridge University Press www.cambridge.org Cambridge University Press 978-1-107-02234-8 — Observation Medicine Edited by Sharon E. Mace Frontmatter More Information Contents Advance Praise x About theEditors xiii Contributors xv Foreword:Onwardand Upward xx Greg L. Henry Preface xxiii Sharon E. Mace Part I Administration: Key 9 MetricsandPerformanceImprovement: Concepts of Observation PatientQuality,Safety,and Experience 48 Medicine, and Developing and Sharon E. Mace and Elaine Thallner Maintaining an Observation Unit Part II Observation Medicine: Clinical 1 Observation Medicine – Key Concepts: Setting and Education HowtoStart(andMaintain)anObservation Unit: WhatYou Need to Know:Clinical Issues 2 10 The Community HospitalPerspective in a Suburban/Rural Setting 58 Sharon E. Mace Ryan Prudoff and Stephen Sayles 2 Observation Medicine – Key 11 The Urban Community Hospital 60 Concepts: How toStart(and Maintain) an Observation Unit: What You Robert S. Bennett Need to Know: Administrative 12 The Tertiary Care HospitalandAcademic Issues 11 Setting 62 Sharon E. Mace Jonathan Glauser 3 Observation Medicine Development 13 Observation Medicine andthe Over Time 23 Hospitalist 64 Louis GraffIV David G. Paje and Peter Y.Watson 4 Observation Medicine Principles 27 14 Training andEducation –Residents 66 Louis GraffIV Pawan Suri 5 Design 30 15 Training andEducation –Medical David Robinson Students/Fellows 68 6 StaffingConsiderations 33 MargaritaE. Pena Christopher W. Baugh and Part III New Developments in J. Stephen Bohan 7 Nursing 37 Observation Medicine Sharon E. Mace and Karen Games 16 Extended and Complex 8 Risk Management 43 Observation 72 Gregory L. Henry L. ChristineGilmore and Bret A. Nicks v © in this web service Cambridge University Press www.cambridge.org Cambridge University Press 978-1-107-02234-8 — Observation Medicine Edited by Sharon E. Mace Frontmatter More Information TableofContents 17 Extended Observation Services 76 Subpart IVC Clinical – Vascular Catherine T.Puetz Editor’sComments:Venous 18 HospitalReadmissions 78 Thromboembolic Disease: Deep Vein Sharon E. Mace Thrombosis and Pulmonary Emboli 158 19 Level of Care Determination: 31 Deep Vein Thrombosis (DVT) 159 Medical Necessity Risk Carol Lynn Clark andMichelle A. Wiener Stratification 88 32 Acute Pulmonary Embolism (PE) 165 Louis Graff IV David G. Paje 20 Accountable Care Organizations 92 33 Anticoagulants 173 Kayur V. Patel and Igor Kozunov David G. Paje 21 Acute Medicine inthe United Kingdom 95 – Subpart IVD Clinical Neurologic Louella Vaughan 34 Transient IschemicAttack (TIA) 180 Matthew Tabbut and Jonathan Glauser Part IV Clinical – 35 Headaches 189 Subpart IVA Clinical Cardiac Sharon E. Mace 22 Chest Pain 98 36 Seizures 200 Tertius T. Tuy and W.Frank Peacock Sharon E. Mace 23 Heart Failure 107 37 Dizziness and Vertigo 211 Jieun Kim and W. Frank Peacock Saurin Bhatt 24 Atrial Fibrillation 114 38 Central NervousSystem (CNS) Catherine T.Puetz Shunts 222 25 Syncope 121 MarkG. Moseleyand Miles P. Hawley T.Andrew Windsorand Amal Mattu – Subpart IVE Clinical Metabolic, 26 Stress Testing 127 Endocrine Kami M. Hu and Amal Mattu 39 Hyperglycemia 225 Subpart IVB Clinical – Respiratory Pawan Suri and Taruna Aurora 40 Hypoglycemia 231 27 Asthma 138 Pawan Suri and Taruna Aurora EricAnderson 41 ElectrolyteAbnormalities 235 28 Acute Exacerbation ofChronic KimberlyA. Ressler and Jonathan Glauser ObstructivePulmonary Disease andBronchitis 143 – Subpart IVF Clinical Hematologic EricAnderson 29 Community AcquiredPneumonia 149 42 Sickle Cell Disease 244 EricAnderson Matt Lyon, Leah Taylor and Robert W.Gibson 30 Primary Spontaneous Pneumothorax 153 43 Transfusions 250 Chew Yian Chai Rokhsanna Sadeghi and Jonathan Glauser vi © in this web service Cambridge University Press www.cambridge.org Cambridge University Press 978-1-107-02234-8 — Observation Medicine Edited by Sharon E. Mace Frontmatter More Information TableofContents – – Subpart IVG Clinical Infections Subpart IVL Clinical Surgical Evaluation 44 SkinandSoftTissueInfections(SSTI) 257 Robert S. Bennett 56 Abdominal Pain 309 Mark G. Moseley and Miles P. Hawley – Subpart IVH Clinical – Gastrointestinal Subpart IVM Clinical Pain Management and Musculoskeletal 45 Abdominal Pain 263 Louis GraffIV 57 Pain Management,Including 46 Upper Gastrointestinal (GI) Bleeding 267 Musculoskeletal andLow Back Pain 312 Nathaniel L. Scott and James R. Miner AbhinavChandra 47 Dehydration, Gastroenteritis, and – Vomiting 271 Subpart IVN Clinical Trauma ElizabethA. Rees andBret A. Nicks 58 Trauma 318 – Mark G. Moseley and Miles P. Hawley Subpart IVI Clinical Genitourinary – 48 Urolithiasis 274 Subpart IVO Clinical Toxicology Claire Pearson and Robert D.Welch 59 Toxicology 323 49 Pyelonephritis and Urinary Tract Steven J. Walsh and Marsha Ford Infections 280 Brian Kern and Robert D.Welch Subpart IVP Clinical – Psychosocial Subpart IVJ Clinical – Obstetrics and Editor’sComments onMedical Clearance 332 Gynecology 60 Psychiatric Patients 332 50 Pelvic Inflammatory Disease (PID) 284 Jonathan Glauser VeronicaSikka andRenee Reid – 51 VaginalBleeding 287 Subpart IVQ Clinical Disasters VeronicaSikka andRenee Reid 61 Disasters 339 52 Hyperemesis Gravidarum 289 ConstanceJ. Doyle VeronicaSikka andHarinder Dhindsa Part V Financial – Subpart IVK Clinical Pediatrics and – Subpart VA Financial Coding and Geriatrics Reimbursement 53 PediatricObservation Medicine 291 62 Physician Coding and Sharon E. Mace Reimbursement 348 54 PediatricObservation Medicine at a Michael A. Granovskyand David Children’sHospital 300 A. McKenzie AderonkeOjo 63 HospitalCodingandReimbursement 355 55 GeriatricObservation Medicine 304 CandaceE. Shaeffer and Michael FredricM. Hustey A. Granovsky vii © in this web service Cambridge University Press www.cambridge.org Cambridge University Press 978-1-107-02234-8 — Observation Medicine Edited by Sharon E. Mace Frontmatter More Information TableofContents – – Subpart VB Financial Case Subpart VIC International Management Australia/New Zealand 64 Determining the Correct Status 363 73 Australia 406 BKKizziar John Burke 65 Case Management: Care 74 New Zealand 409 Coordination 366 Michael Ardagh Nancy E. Skinner – Subpart VID International Europe – Subpart VC Financial Medical 75 France 411 Necessity, Denials, and Appeals Said Laribi andPatrick Plaisance 66 Medical Necessity 370 76 Germany 413 Robert H. Leviton Martin Mockel and Julia Searle 67 Denials andAppeals 378 77 Italy 417 Robert H. Leviton Salvatore Di Somma, Angelo Ianni, and Cristina Bongiovanni Subpart VD Financial – The Business 78 United Kingdom 421 Louella Vaughan and Dylan Jenkins of Observation Medicine 68 Ensuring Financial Viability:The Business – Subpart VIE International South Case for Observation Units 382 America Christopher W.Baughand J.Stephen Bohan 79 Colombia 424 69 Observation Servicesin the Eyes of the Carlos-Hernan Camargo-Mila Payers 386 Sandra Sieck Part VII Evidence Basis for 70 The Business ofObservation Medicine 391 Observation Medicine Sandra Sieck 80 The Evidence Basis for Observation Medicine inAdultsBased onDiagnosis/ Clinical Condition 430 Part VI International Christopher W.Baugh, Sharon E. Mace, – Subpart VIA International Africa Margarita E. Pena, andJ. Stephen Bohan 71 South Africa 398 81 The Evidence Basis for Age-Related Observation Care 478 Heather Tuffin andLA Wallis Sharon E. Mace, Christopher W. Baugh, andMadelineJoseph – Subpart VIB International Asia Part VIII Clinical Protocols 72 Singapore 403 Malcolm Mahadevan and Chew Author’sandEditor’sComments: Yian Chai Protocols andOrderSets 511 viii © in this web service Cambridge University Press www.cambridge.org Cambridge University Press 978-1-107-02234-8 — Observation Medicine Edited by Sharon E. Mace Frontmatter More Information TableofContents 82 ClinicalProtocols 514 90 Adult Order Sets: Electrolyte Sharon E. Mace Abnormalities 705 Sharon E. Mace and MatthewJ. Campbell Specialized Clinical Protocols 547 83 Spontaneous Pneumothorax 548 91 Adult Order Sets: Trauma 713 Chew Yian Chai Sharon E. Mace 84 Snakebites: Rattlesnake Bites 556 92 Adult Order Sets: Intravenous Fluids, Sean Bush Laboratory, Radiology, andSpecial Studies 729 85 Snakebites: NorthAmerican Crotalid Snake (PitViper) 560 Sharon E. Mace and MatthewJ. Campbell Bret A. Nicks 93 Adult Order Sets: Medications 733 86 Dengue 565 Sharon E. Mace and MatthewJ. Campbell Chew Yian Chai 94 Adult Order Sets: Genericor General 87 Low-Risk Pulmonary Embolism (PE) 567 Order Set 748 Sharon E. Mace David G. Paje – Part IX Administrative Policies Subpart XB Order Sets Pediatrics 88 Administrative Policies 570 95 PediatricOrder Sets: Medications 752 Sharon E. Mace Sharon E. Mace and MatthewJ. Campbell 96 PediatricOrder Sets: Generic or General Part X Order Sets Order Set 762 – Sharon E. Mace Subpart XA Order Sets Adult 89 MedicalCenter Department of Emergency Medicine Observation UnitManual:Adult Prologue: Observation MedicineIs Not the Order Sets by Diagnosis/Clinical Same asObservation Status 766 Condition 602 Sharon E. Mace and Robert E. O’Connor Sharon E. Mace Index 769 ix © in this web service Cambridge University Press www.cambridge.org Cambridge University Press 978-1-107-02234-8 — Observation Medicine Edited by Sharon E. Mace Frontmatter More Information Advance Praise This is a wonderful, much needed book by a practice. The included clinical protocols, alone, wonderful, much learned author. Dr. Mace has are worth their weight in gold; they will give you decades of experience in observation medicine an excellent basis for the wide range of problems andevenmoreinemergencymedicineleadership. wecansafelydealwiththroughobservationmedi- Thisbooknotonlyincludesthebestsummaryto cine. I just wish we had access to the knowledge date of what EM observation medicine has been and wisdom contained in this book when we butalsoprovidesaroadmaptothefuture.Ifyour started our observation unit in 1979! practice includes observation medicine, you need Stephen V. Cantrill, MD, FACEP this book. Rock on, Dr. Mace. DenverHealthMedical Center NickJouriles,MD,FACEPChair,EM,Cleveland University of Colorado School of Medicine Clinic Akron General: Professor & Chair, EM, Northeast Ohio Medical University; President, Observation medicine is the perfect tool for pro- ED Benchmarking Alliance; Past President, gressive emergency physicians to leverage American Collegeof Emergency Physicians improvements in cost, quality and patient satis- faction. I have seen physician groups and hos- “Observation Medicine: Principles and Proto- pitals struggle to collect all the information cols” edited by Dr. Sharon E. Mace is a relevant necessary to build and run an observation medi- and timely textbook to Emergency Medicine. It cineserviceeffectively,sometimestakingyearsto hasuniquecontentasitrelatestothedevelopment get it right. We have needed this book for a long of both adult and pediatric observation medicine. time, and now it’s here – a single source for the Thebookiswritteninaneasytoreadformatwith best information on what, why and how to many outstanding ideas on how to implement developanobservationservicethatlastsandadds observation medicine in the emergency depart- value to yourhospitalpartner. ment.Thisisanindispensableresource! James R.Blakeman IsabelA.Barata, MS,MD, MBA,FACP, FAAP, Executive Vice President FACEP Emergency Group’s Office, San Dimas, CA Associate Professor of Pediatrics and Emergency Dr. Mace’s Observation Medicine is a must have Medicine,Hofstra NorthwellSchoolofMedicine; forallphysiciansandadministratorswhohaveor PediatricEmergencyMedicineServiceLineQual- would like to start an observation unit. Jammed ity Director, Emergency Medicine and Pediatrics with helpful tips, useful clinical protocols and Service Line; Director of Pediatric Emergency administrative guidelines, it will guarantee the Medicine,North ShoreUniversity Hospital success of your program!! Finally!Afterdecades,anup-to-dateauthority Ann M Dietrich,MD, FAAP, FACEP onobservationunitsandobservationmedicine.If Associate Professor Ohio University Heritage you are in any way involved in this dynamic College of Medicine aspect of emergency medicine, this book is for Medical Director of EducationOhio ACEP you. From the clinical to the administrative to the convoluted billing and regulatory issues, this Asalongstandingresidencydirector,itisdiffi- bookisawealthofinformationthatwillhelpyou culttoprovidethetrainingneededtokeepupwith navigate this complex area of emergency medical theadvancementsinemergencycare.Observation x © in this web service Cambridge University Press www.cambridge.org Cambridge University Press 978-1-107-02234-8 — Observation Medicine Edited by Sharon E. Mace Frontmatter More Information AdvancePraise medicine is proving to be an extremely valuable Chair, Department of Emergency Medicine, additiontoemergencycare,andemergencymedi- Michigan State University Grand Rapids, cine residents need to be exposed and trained in Michigan thisfacetofemergencycare.Dr.Mace’stextbook, ObservationMedicine,providesavaluabletraining The Textbook Observation Medicine: Prin- resourceusefultoallemergencymedicineresiden- ciples and Protocols edited by Sharon E. Mace is cies. This textbook provides the background amusthaveinyourEmergencyMedicineLibrary. needed to not only work within an emergency Dr. Mace, an experienced Emergency Physician department that has an Observation unit, but practicing Observation Medicine for Adults potentiallytodevelopone.Thisisagreatresource and Children at the Cleveland Clinic Hospital fortraininginObservationMedicine. Systemfordecades,hasassembledateamofcon- tributors representing the best and brightest of MichaelS. Beeson, M.D., MBA Emergency Medicine. In the ninety-six (96) ProgramDirector of Emergency Medicine Chaptersofthisbook,thereaderwilllearnevery- Professor | EM | Northeast Ohio Medical thing you need in implementing an Observation University Unit for your Emergency Department and your Director | American Board of Emergency hospital. The breath of this book is exhaustive. Medicine Thechaptersareorganizedintomultiplesections. Cleveland Clinic Akron General They include: “Administration, Clinical Setting and Education, New Developments, Financial Thefaceofhealthcareischangingandthatisa (including coding and reimbursement), Clinical goodthing.However,weareastubborngroupand change is difficult. Dr. Mace’s book describes Protocols, Administrative Policies, Order Sets for Adults and Pediatrics,and muchmore.” observationcareinamannerthatiseasilyunder- Economics and the desire to provide optimal stood by all healthcare providers and administra- care for Emergency patients who needed just a tors. What we are unfamiliar with We are afraid of...Dr.Mace’sbookwillprovidetheknowledge littlebitmoretimetostabilizetheircare,arriveat a definitive answer, or prepare patients for safe you need to embrace the change and leverage the discharge home without a hospital admission, observation services you deliver. As a nurse, we helped to drive the development of this special- continue to care for our patients the same as we ized area of Emergency Medicine. alwayshavebutinashorterspanoftime,thisbook As written, in the forward by Greg Henry, sharesinvaluableinformationinresourcemanage- MD, FACEP, (Past President of the American ment,timemanagementandexpeditedcareman- College of Emergency Physicians), “Remember agement.ThisbookisaMUSTHAVEforsuccess the goals: cost-effective care, time-efficient care, inourevolvinghealthcareenvironment. thebestpatientoutcomes,andmorecompassion- Ethel Games, RN ate human-centered care. Observation medicine Emergency Room Nurse can achieve thesegoals.” FountainValleyRegional Hospital This book can help establish an Observation FountainValley,California Unit as part of your Emergency Department through its guidance of Administration, Proto- This text willserve as the “go to"resource for cols,exploringthetypesofClinicalProblemsthat health care providers managing patients in an would best be served by these units. They also observationunit.Thebookiswellorganizedwith bring in the experts of reimbursement to help chapters that focus on the content most relevant you pay for the services you provide. If you to contemporary observation medicine. There is already have an Observation Unit, this book is no doubt it will become required reading for the essential to operating that unit correctly and at a observation medicine curriculum in EM resi- higher level. If it is your responsibility, as an dency programs. EmergencyDepartmentLeader(Director,Associ- MichaelBrown, MD, MSc ate Director, or responsible for medical or nurs- Professor, Michigan State University College of ing education), the protocols and educational Human Medicine modules willmake your life easier. xi © in this web service Cambridge University Press www.cambridge.org
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