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Recommendations for the Evaluation and Management of Observation Services: A Consensus White Paper The Society of Cardiovascular Patient Care

Peacock, Frank MD, FACEP*; Beckley, Philip PhD; Clark, Carol MD, MBA, FACEP; Disch, Maghee MSN, RN, CNL, CHFN; Hewins, Kelly MSN, RN, CEN, CPHQ; Hunn, Donna RN, MSc, MAN, ANP-C; Kontos, Michael C. MD, FACC, FAHA§; Levy, Phillip MD, MPH, FACEP; Mace, Sharon MD; Melching, Kay Styer MSA, RN, BSN, CPHQ; Ordonez, Edgar MD, MPH*; Osborne, Anwar MD, MPM, FACEP**; Suri, Pawan MD§; Sun, Benjamin MD††; Wheatley, Matt MD**

Critical Pathways in Cardiology: December 2014 - Volume 13 - Issue 4 - p 163–198
doi: 10.1097/HPC.0000000000000033

Observation Services (OS) was founded by emergency physicians in an attempt to manage “boarding” issues faced by emergency departments throughout the United States. As a result, OS have proven to be an effective strategy in reducing costs and decreasing lengths of stay while improving patient outcomes. When OS are appropriately leveraged for maximum efficiency, patients presenting to emergency departments with common disease processes can be effectively treated in a timely manner. A well-structured observation program will help hospitals reduce the number of inappropriate, costly inpatient admissions while avoiding the potential of inappropriate discharges. Observation medicine is a complicated multidimensional issue that has generated much confusion. This service is designed to provide the best possible patient care in a value-based purchasing environment where quality, cost, and patient satisfaction must continually be addressed. Observation medicine is a service not a status. Therefore, patients are admitted to the service as outpatients no matter whether they are placed in a virtual or dedicated observation unit. The key to a successful observation program is to determine how to maximize efficiencies. This white paper provides the reader with the foundational guidance for observational services. It defines how to set up an observational service program, which diagnoses are most appropriate for admission, and what the future holds. The goal is to help care providers from any hospital deliver the most appropriate level of treatment, to the most appropriate patient, in the most appropriate location while controlling costs.

From the *Baylor College of Medicine, Ben Taub Hospital, Houston, TX; Society of Cardiovascular Patient Care, Dublin, OH; Beaumont Health System, Royal Oaks, MI; §Virginia Commonwealth University Medical Center, Richmond, VA; Wayne State University School of Medicine, Detroit, MI; Cleveland Clinic, Cleveland, OH; **Emory University School of Medicine, Atlanta, GA; and ††Oregon Health & Science University, Portland, OR.

About Society of Cardiovascular Patient Care

The Society of Cardiovascular Patient Care (SCPC) is an international not-forprofit organization leading the fight to eliminate heart disease as the number one cause of death worldwide. SCPC focuses on transforming cardiovascular care by assisting facilities that create Cardiovascular Communities of Excellence bringing together quality, cost, and patient satisfaction. SCPC provides the support needed by hospitals to effectively bridge existing gaps in treatment by providing the tools, education, and support necessary to successfully navigate the changing face of health care.

Reprints: Casey Strader, Society of Cardiovascular Patient Care, 6161 Riverside Drive, Dublin, OH 43017. E-mail:

© 2014 by Lippincott Williams & Wilkins