By Tom Tinsman, MD
I’d like to mention some additional review suggestions that should be helpful in your review work. These were illuminated by our latest Interrater Reliability (IRR) study.
When a patient is admitted for a scheduled procedure, where the normal, expected course would be only overnight monitoring, the admitting physician is required to use the Observation status for the initial admission.
Clearly, if a patient is having an elective procedure, the patient would be presumed to be otherwise without acute medical issues that would be expected to cause a complicated post-operative course, and a stay of more than 24 hours. The provider always has the option to convert the admission to acute care, if unexpected complications extend the stay.
If the admitting physician specifically documents an anticipated stay of more than 24 hours at the time of admission, and if the clinical reasons are valid for this expectation, then an acute care admission should be allowed. Allow the acute care admission even if the patient is discharged in less than 24 hours. Physicians are not expected to foresee the exact clinical course of a patient. They should base the anticipated length of admission on what is known at the time of that admission, plus the duration of treatment from experience.
Denying an acute care admission, which would normally be expected to require more than 24 hours of treatment because the patient did better than expected and was discharged in less than 24 hours, is not in the spirit of one of AFMC’s basic tenets of review.
Dr. Tinsman is an associate medical director at AFMC and team lead in AFMC’s review department.