Q&A: Outpatients receiving observation services

CDI Blog - Volume 11, Issue 97

Q: Under what circumstances would it be appropriate for a patient who does not meet inpatient criteria to be registered as outpatient receiving observation services?

A: A patient who does not meet inpatient acuity criteria might still qualify to receive observation services. Patient access staff must understand the general concepts of this status to help them track patients for admission or discharge within 24 hours and to identify questionable admissions. Most observation patients originate either as direct-admit patients, prescheduled admission, or though the emergency room.

Observation services may be appropriate in the following circumstances, and care must include active assessment of their condition during the observation period:

  • Patient evaluation for possible inpatient admission
  • Treatment that is expected to last 24 hours or less
  • Resolution of medical complications following outpatient surgery or procedures

Observation status cannot:

  • Substitute an inpatient admission
  • Substitute for normal post-procedure recovery time
  • Be used for patients awaiting nursing home placement or for convenience purposes
  • Be used for routine procedure preparation

Editor’s note: This article originally appeared in Revenue Cycle Advisor. For information, see The Complete Patient Access Handbook.


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