Case Management Observation vs. Admission List

click for a printable copy

Automatic Admission

It should be noted that
all automatic admissions
need to meet MCG guidelines

All ICU and ICR cases

Any multilobar pneumonia

Any pneumonia with significant hypoxia

Acute respiratory failure/Pulmonary Edema

Any patient who is deemed obvious that the patient will stay longer than 2 midnights based on their presented conditions

Acute altered mental status/metabolic encephalopathy

Any patient with an initial presentation and documented diagnosis of:
     ♦Severe sepsis
     ♦Acute respiratory failure
     ♦Hemodynamic instability
Any end state cirrhosis patient admitted for complications of end state cirrhosis
Acute medical illness in patient with severe malnutrition
Any infection in an immunocompromised patient
Acute MI


Additional Evaluation
These cases need additional review by the CM
with the ED Attending before
a decision to place a patient on observation
or inpatient admission

All neuro, CVA’s, Syncope patients
All primary CHF
All admissions from Nursing Homes
All GI bleeds/Digestion Disorder
All exacerbations of COPD
All patients with positive troponins
Severe hyponatremia (sodium less than 125) or hypernatremia
All pulmonary embolus
Cellulitis with evidences of SIRS
Overdose - Alcohol Abuse & Dependence
All oncology patients
Hypertensive emergencies
UTI and Kidney Infection
Renal Failure
Cardiac Arrhythmia & Conduction Disorders
Automatic Observation
Chest pain with negative troponins
Patients for Cath
Asthma exacerbation in otherwise healthy individuals
Patients admitted for pain control
Patients with SVT otherwise complicated
Patients admitted for Social Reasons x
Uncomplicated DVT
Poorly controlled hypertension but not requiring IV drips to control
Syncope & Collapse



Automatic Admission

Patients who need to be stabilized with IVAbx, etc. prior to surgical interventions

All Trauma cases

All neurosurgical case

Orthopedic cases admitted to trauma


Automatic Observation
Strangulated hernias
Perirectal or other abscess requiring operative or IR drainage
Any patient with the same diagnosis but with comorbidities need CM review*


Admit for any of the Admission reasons above, otherwise place all patients on Observation

Weekend Issues:
These are weekend issues that need to be addressed but the patients should remain on observation unless they meet inpatient criteria after the procedure



Click to return to the ER Home Page