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Wichita EM

Psych Obs Status

Criteria

Section titled “Criteria”
  • Anyone we cannot immediately disposition (admit directly to the unit or discharge) we place into this” ED Psychiatric Observation Status” in order to start the clock
    • For direct AMG admissions at St. Joseph do NOT place them in “ED Psychiatric Observation Status” since AMG rounds and cares for these patients.
  • Date and Time based on your initial evaluation.
  • Can do it for all BH patients at Teresa and Francis, even for AMG admissions.
  • Place KU, Comcare, and Camber psychiatric admissions into this “ED Psych Observation Status” at all EDs since we round on them, and provide ongoing care until they leave the department.
Psych Observation Tip Sheet

Steps to Follow

Section titled “Steps to Follow”

Place the following in the “Impression and Plan” portion of your note for easy identification by coders.

  1. Insert the “Admit to Psychiatric Observation” macro. Date and Time this admission as noted above once you determine they will need an observation period while pursuing ongoing treatment/assessments/re-evals/etc.

  2. There will ultimately be 2 separate admitting dispositions on psychiatric admissions. The first is the “Admit to ED Psychiatric Observation” as detailed above in #1. The second admitting disposition is the typical admit order to the psychiatrist that you are used to documenting. A picture example of how your final disposition section should look is provided below:

  3. You may be overseeing the care of someone who overdosed, is severely intoxicated, needs psychiatric assessment (KU, Comcare, LSCSW, etc.) and qualifies for the admission to ED psychiatric observation criteria, but then later is cleared and determined to be safe for discharge. In that case, it is important to capture the time spent observing the patient and the specific amount of time performing the discharge plan/process with/for the patient. Please insert the “Discharge from Psychiatric Observation” macro as shown below and adjust the time spent observing the patient.

  4. The minimum time billable for this observation status is 8 hours, so it is most likely that the patient will be signed out to a different physician and this disposition macro will be most applicable on an “Assumption of Care” pre-completed note or “Psychiatric Continuation Note”.  Please keep in mind that this disposition macro also applies if the patient is discharged from the emergency department days after initially being admitted to Inpatient Behavioral Health. If we discharge a patient after ED Psychiatric Observation, then we must put in how many minutes we spent working on discharge process/plan with that patient (less than 30 minutes is coded at a lower rate and 31 minutes and above at a higher rate).

  5. There are no changes you need to make at this time to the “Psychiatric Continuation” pre-completed note. The macro has been adjusted to reflect these charting changes. It is shown in the picture below. Again, this macro is automatically pulled into the pre-completed template, you do not have to make any adjustments to how you document your psychiatric continuation notes at this time unless you change the plan (i.e. discharge to partial day, transfer, send to COU/Comcare, home, etc).