ED Observation 24/7 as of June 1, 2015

Dear Colleagues,
1)  The Observation unit is now open 24/7.
2)  There are always 2 nurses scheduled for the unit even if there is only one there at the time you have a candidate patient.  Therefore, the provider should speak to the Charge Nurse, in addition to the Obs NP so that the charge nurse can assign a second RN to the unit when the 7th to 10th patients are to be transferred there.
3)  Providers should also speak to the team nurse when availability in the unit is confirmed.  This ensures an early transfer of the patient to the unit.
4)  If the unit is full consider admitting all subsequent medicine patients to the non-teaching service – if appropriate.
5)  Remember to list, in the HMED disposition page, the patient was “Admitted because there are no Obs beds” when this is the case.
6)  ED Attendings ONLY:  If you have a possible obs candidate with a diagnosis not on the list of approved obs diagnoses you may have an in-person conversation with the Obs attending.  Selected cases will be approved for transfer by the Obs attending only.  This conversation should be had when the Obs attending is on duty.  The Obs attending will instruct the NP on how to proceed with the care of patients with diagnoses not on the list.  The Obs attending is not available after 11 PM for these conversations.  Candidates for Obs care (with diagnoses not on the approved list) evaluated between 11 PM and 9 AM should either be admitted or held until the attending comes in at 9 AM.