UNASSIGNED: 96 Background: CMS defines Observation Services as outpatient care ordered by a physician and provided in a hospital bed to determine the need for inpatient admission or discharge. Recent CMS rules on Observation stay and 2-midnight rule has created confusion amongst Medicare beneficiaries, providers and hospitals. Two-thirds of US hospitals deliver observation care without using an observation unit. Review of our hospital observation care and a survey of @entity5 Centers within the Alliance of Dedicated @entity5 Centers revealed that observation care was provided in a bed anywhere in the hospital with unstructured care provided at the discretion of the treating physician. This leads to less favorable outcomes compared to protocol driven and closed observation units (Type 1). METHODS: Plan- Institutional stakeholders consisting of administrators, hospitalists, @entity2613 physicians, case managers and nurse managers developed an observation services guideline policy and project team. Do- pilot initiated with @entity2613 admitting Observation @entity1 to dedicated hospitalist providers and unit. Order sets were developed, education and staff training was provided and target start date set. Baseline and performance measures were developed. Study- impact on @entity2613 flow, admissions, @entity2613 length of stay, provider satisfaction, diagnoses, @entity1 case-mix, and financial costs. Act- Implemented changes and lessons learned from pilot Results: Before implementation of pilot less than 10 @entity1 per month were placed in observation status (Sept 2011- Aug 2012). After pilot average of 30 @entity1 per month were initially placed in Observation (Sept 2012-April 2014). Approximately 73% of @entity1 placed on observation are discharged and not admitted. Observation counts for approximately 25,000 dollars in professional charges per month. @entity2613 LOS decreased to less than 6-hours. @entity1 satisfaction and @entity2613 provider satisfaction scores have improved. CONCLUSIONS: Majority of Observation @entity1 are not admitted thus avoiding the higher cost associated with inpatient stays with resulting cost saving. @entity2613 wait times have improved leading to less over-crowding with @entity2613 physicians having time to see more @entity1 .

Utilizing TQM and CQI prinicples in establishing a Type 1 observation unit in a comprehensive XXXX center.

@entity5 :: ('MESH:D009369', 'Disease') :: ['Cancer'] @entity1 :: ('9606', 'Species') :: ['patients', 'patient', 'Patient'] @entity2613 :: ('MESH:C536181', 'Disease') :: ['ED']
@entity5 :: (MESH:D009369,Disease) :: ['cancer']
