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

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

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

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

Post-Procedure Status Determination : OIB 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

Post-Procedure Status Determination : Observation 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

Post-Procedure Status Determination : In-Patient 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

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

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 (F9) Select the location and then hit “Submit”

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

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

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

Questions?