Extended care is the period when care and interventions are required following discharge from Phase I and Phase II recovery. Many patients require further observation and extra time prior to being transported to an inpatient care bed or leaving the health-care facility. They may be awaiting transportation, have no care provider at home, require further observation for potential complications, or be waiting for the availability of an inpatient bed. This chapter describes some of the regulations and practice considerations as they relate to extended care patients. The terms extended care and observation care will be used interchangeably throughout this chapter.
2.What criteria are used to utilize the postanesthesia care unit (PACU) for observation care?
3.Is short stay, 23-hour observation equivalent to extended care?
4.Should there be a limit on the length of time a patient can be classified as an extended care patient?
5.What CMS rules and regulations will be imposed in creating an observation category?
6.What does not qualify for outpatient observation?
7.What standards of care are used for extended care patients?
8.Are there specific admission criteria for a patient to be considered an extended care patient?
9.What staffing requirements are needed to cover extended care patients?
10.Is there a specific nurse-to-patient ratio requirement for extended care?
11.What types of nursing personnel are needed?
12.What monitoring requirements for observation care are needed?
13.Can ICU patients be managed in this category while awaiting bed placement in the ICU?
14.What documentation requirements are needed?
15.How frequently are vital signs required?
16.Who is responsible for the ultimate management of the patient?
17.Is there a time limit attached to the category of extended observation?
18.Is extended observation an extension of Phase II PACU care?
19.What criteria are required for discharge?
20.Where will the patient be discharged or transported to following observation care?
21.Are transport policies and procedures necessary for sending patients to a higher level of care from a freestanding facility?
22.When are discharge instructions given?
23.Should patients be discharged with a “responsible adult,” or is this not necessary because they have recovered from extended care?
24.Are post-procedure/post-discharge phone calls necessary?
25.Will family members have the opportunity to visit and assist with patient care in the observation unit?
26.What level of care is provided to patients who are categorized as extended care?
27.Is there a limit to the types of orders implemented during the patient’s stay as an extended care or observation care patient?
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