After lunch, Trevor Lewis, MD, kicked things off with a presentation called, Engineering the Observation Unit. As you might expect from the title, he provided an overview for to create and manage observation units. Starting with unit goals and building support for an obs unit, Lewis detailed many of the issues revolving around staffing these units. Policy and procedures described admission protocols, diagnostic testing and capturing data for optimization. The presentation included a lot of great suggestions for integrating an obs unit into the rest of the hospital”s (and attending physician's) operations.

Introduced as a “reimbursement geek,” Konstantinos Agoritsas, MD, was next up talking about revenue opportunities in the ED with observation care coding. He practices at a SUNY hospital where he works with residents and some of the older staff to educate them on proper coding. The focus was on proper and complete documentation, patient classification issues, and the proper way to code for complete reimbursement. Also presented was an interesting financial model based on a very modest patient volume.

A panel discussion on overcoming observation patient management challenges. The panel included a physician and 2 directors of case management. There were lots of questions and discussion on ensuring observation patient support in the EMR. The expansion of diagnostic services was also implemented to ensure timely testing and patient flow. What followed were a lot of questions about the nitty gritty operation of ops units.

The final presenter for the day was Beth Simms, Network Coordinator, Outpatients in Beds/Observation Care Management, Community Health Network in Indianapolis. Her focus was on the impact of nursing on observation patient management and drug administration. Community Health has 4 hospitals, 2 of which have dedicated observation units and 2 that don't. Community has noted that LOS is shorter in hospitals with dedicated observation units, where staff is experienced in managing observation patients.