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Am I part of the In Crowd? Observation versus inpatient admission

nurse-with-teen-patientHas this scenario ever happened to you? You rush your child to the Emergency department.  And while she starts looking a little better, you’re frightened at the prospect of being sent home in case things take a turn for the worse.

Then the doctor comes in to calm your fears – or does he?

“We think we need to keep her in the hospital,” he says, “so we are going to make her a 23-hour observation.”

What does that mean?  Will you really be camping out in the Emergency department for the next 23 hours?

Observation status is intended for children who are on the fence between admission and discharge.  If a child doesn’t meet generally accepted criteria for admission to a hospital, observation status gives hospitals a way to prolong an outpatient visit until the child is either clearly well enough for discharge, or becomes worse and does meet admission requirements.

From a parent’s perspective, things won’t look much different either way.  Your child will go up to a regular patient room, see the same nurses and doctors as admitted patients, have whatever testing and treatments are required, and be assessed for changes in condition.

Oh, and that 23-hour part, it’s really an outdated term. Nothing magical happens at the 23rd hour.

Generally your doctor will decide within a day or so whether your child is well enough to go home, or needs to be admitted to the hospital. In rare circumstances, that period can extend to 2 or more days.  Again, from your perspective, if your child gets fully admitted to the hospital, nothing will change — same nurses, same doctors, same good care.

Why make such a big deal then?

The major difference comes down to healthcare payment. As long as a patient is on observation status, for insurance purposes, she is an outpatient, even if she’s been in the hospital for 2 days.

This may affect the portion of the hospital bill for which you’re responsible since it’s considered an outpatient service and not a hospitalization as far as your insurance company is concerned.

It’s important to remember that doctors make decisions about observation status and inpatient admissions based upon your child’s best interest, healthcare law and standard practices. They don’t simply pick the one that’s convenient or because it’s what you want to hear.

Here are some tips to keep in mind the next time you take your child to the ER:

  • If we plan to keep your child in the hospital, ask your doctor if he will be fully admitted or on observation status.
  • Review your insurance information to be sure you understand the difference between coverage for observation status and admission for you as a consumer.
  • If your child is on observation status, follow up with your doctor during rounds the next day.  Ask about any changes in status — remember the options are discharge, a full admission, or no change at all.

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About Dr. Eugene Mowad - Pediatric Hospitalist

Dr. Eugene Mowad is a board-certified pediatrician who specializes in the care of hospitalized children. He and his wife have 3 daughters, and in his free time, he's a musician and enjoys cooking and wine-making.

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