OUTPATIENT IN A BED OIB PROCESS INTRODUCTION What

OUT-PATIENT IN A BED (OIB) PROCESS

INTRODUCTION What is Out-Patient In a Bed (OIB)? • OIB is defined as an out‐patient that requires an extended length of stay beyond normal clinical discharge criteria. • the additional length of stay does not qualify for “in‐patient” status under Admission Criteria, nor does it qualify for “observation” status under Observation Criteria 2

GUIDELINES FOR OIB • “OIB” time begins when the out‐patient arrives on the nursing unit and provision of care begins • “OIB Time” ends when the out‐patient is discharged from the nursing unit AND physically leaves • OIB stays will be “statistically” charged on a “per hour” basis ‐ (OIB statistics not being implemented in ICU, Family Birthing Center and Emergency Room) Case management must review each OIB patient daily for appropriate extended stay reason and timely discharge 3

GUIDELINES FOR OIB – cont’d • An OIB extended stay requires a Physician Order. ‐ The order needs to be in writing, signed, dated and timed and should read “Keep patient as Outpatient in a Bed (OIB)”. ‐ The medical record will indicate documentation of the reason for extending the out-patient stay 4

GUIDELINES FOR OIB – cont’d • An OIB extended stay would also require a Physician Discharge Order. ‐ The discharge order needs to be dated and timed ‐ It can include a nurse appropriately signing off on a verbal physician order 5

POST-PROCEDURE STATUS DETERMINATION : OIB I. OUT-PATIENT IN A BED ‐ used for post‐scheduled procedure or surgery only ‐ not used for emergent, urgent or direct admissions • Patient may stay overnight with anticipated discharge the next day • Used for routine recovery that requires overnight monitoring • Used for expected post‐op nausea, pain or other expected post‐op symptoms 6

POST-PROCEDURE STATUS DETERMINATION : OBSERVATION II. OBSERVATION SERVICES – used for post‐procedure or surgery that requires extended observation and treatment of a symptom or condition that is out of the expected post‐op norm • Used when a post‐op symptom or condition persists for more than 24 hours despite treatment • Requires documentation as to the specific symptom or condition which warrants monitoring, how this issue is being treated and why continued hospitalization is required ***Consult the Case Manager whenever possible before converting Out-Patient in a Bed (OIB) to Observation Services 7

POST-PROCEDURE STATUS DETERMINATION : IN-PATIENT III. IN-PATIENT – used for post‐procedures deemed as “in‐patient” on the Medicare Inpatient Only list or by the claims payer • Used when a condition warrants the proposed or preauthorized Out‐Patient procedure not be performed, instead, a procedure which is considered an In‐Patient procedure is required • Used when an untoward event intra‐op or post ‐procedure or surgery causes hemodynamic instability and requires ongoing treatment • Requires determination as to the specific symptom, condition or procedure being treated, how this issue is being treated and why it requires continued hospitalization ***Consult the case manager whenever possible before converting Out. Patient in a Bed (OIB) to In-Patient status 8

ORDER ENTRY : OIB How to Order OIB : From “Orders/Any Orders”, search on and select “OIB” and press “Done” 9

ORDER ENTRY : OIB - cont’d Press “Done” again, and the window with “Req’d Queries are Missing” will pop up. Go to Location and do a look-up (F 9) Select the location and then hit “Submit” 10

OIB DEPARTURE How to “Depart” an OIB Patient: From Meditech main menu, got to “ADM. CSB”, and choose “ 27. Depart SDC (OIB Patients)” 11

OIB DEPARTURE The “Depart” screen is similar to the Discharge screen, only that they refer to different patient status. 12

OIB DEPARTURE When a “Patient look-up” is done, all active patients will be highlighted, however, if a patient is chosen and is not an SDC/OIB patient, an error message will appear. *SDC – Same Day Care 13

QUESTIONS? 14

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