Modifications to Level of Care Orders

This is to inform you of upcoming modifications to the level of care order set selections. Changes will affect paper and electronic order sets used to communicate/document initial and subsequent level of care changes.  A clear patient status order must be established prior to registering the patient as an inpatient. Also, a clear patient status order of outpatient with observation services must be established prior to registering the patient as outpatient and beginning observation services in a hospital bed. This valid patient status order should also be dated and timed. These changes do not apply to ED bridge orders.

 The new verbiage supports CMS requirements for documentation of level of care.  

 The 3 selections are:

IP – Admit to Inpatient

OP – Place in Outpatient

OPBO – OP begin Observation


Admit to Inpatient (IP): Patients who are admitted to a hospital for bed occupancy for purposes of receiving inpatient hospital services. The word “Admit” is not used as a “stand alone” order and not appropriate to use when ordering outpatient levels of care.

Place in Outpatient (OP): Used for ambulatory surgery patient types and outpatient procedures. An ambulatory surgical patient with no post-operative complications should be placed in outpatient level of care (OP) even, if there is a planned over-night stay in the hospital.  Other examples: scheduled outpatient infusion of blood products or chemotherapy or a scheduled cardiac catheterization procedure.

Outpatient Begin Observation (OPBO): Intended use is for short-term diagnostic testing and monitoring which are reasonable to evaluate the patient’s condition. OPBO level of care should not be used for monitoring in critical care areas of the hospital. Patients in OPBO level of care may be located in all other adult or child medical/surgical units as well as the emergency department services. Normally more than six hours of treatment will be required and physician decision to discharge or “admit to inpatient” level of care is typically less than 24 hours. In some situations, OPBO can extend beyond 24 hours.  OPBO is used for an ambulatory surgery patient that may need monitoring due to complications post procedure.

Target start date: April, 2012.  For questions contact Beth Reinhart at 540-498-4487.

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