Concept: Observation Units & Admission Policies Across Winnipeg Hospitals and Emergency Departments
Last Updated: 2004-10-22
Non-Uniform Policies and Counting Inpatients
Note: hospital occupancy is inflated when the patient remains in the observation unit or hallway until separation.
A. Hospital Admission Policy TrendsNotes
The following table contains information obtained from each hospital to support documentation of the WHA Planning and Management Information System (July 1998).
Table 1: Hospital Admission Policy Trends
Hospital Definition/Coding Practice Grace General Hospital - Patients are abstracted when they have been admitted as inpatients after a 24 hour stay in hospital. This practice of abstracting has been more consistent in last 2-3 years. Also, patients may be admitted after 24 hours from the ER.
Misericordia General Hospital (Note: as of 1998, LTC facility) - When the attending physician gives the order for admission, the case is abstracted upon discharge as an inpatient (even if the complete hospital stay is within the OU). There is no automatic admission criteria for OU patients.
St. Boniface General Hospital - Considered inpatient admission when a physician has documented that an admission is required (i.e., admit when bed available). St. Boniface does not automatically admit after 24 hours in the observation unit.
Victoria General Hospital - Patients in the observation unit become inpatients upon a physician's order to admit.
Concordia Hospital - Patients are admitted after 24 hours although this practice is not always automatic if nursing staff are unsure. Prior to Oct. 1996, the time of admission for these patients was back dated to the time of admission to ER. This has since been changed to reflect time when inpatient admission occurred.
Seven Oaks General Hospital - Patients are abstracted if an admit order is written. There is no established policy regarding the time frame that holding/reassess patient requires an admit order.
Health Sciences Centre - Contact HSC directly.
Further to this information from the Regional Director of Bed Utilization (WRHA) sent the following information dated June 23, 2000.
"... there appears to be little or no policy regarding admissions, but each facility has a standard practice that is followed. A recently formed committee to standardize data elements will be looking at this issue from a regional perspective this fall (2000)."B. Admission Coding Practices
Hospital Definition/Coding Practice
St. Boniface General Hospital Current practice is to admit the patient when an admission order is written. Patient can be admitted and remain in the ER when no beds are available.
Seven Oaks General Hospital Patients are admitted after a written order for admission is left.
Grace General Hospital Current practice is to admit a patient only when an admit order is written.
Health Sciences Center practice varies slightly depending on the service the patient is being admitted to. Generally patients are admitted upon an order, but the admit date and time is generated once a patient is discharged from emergency and admitted to an inpatient bed. Victoria General Hospital Patients are admitted on a physician's order.
Concordia Hospital Patients are admitted on a physician's order.
This information has been updated with the following information received from Rosemary McDowell at Manitoba Health (August 24, 2004).
The provision of health care is entrusted to the Regional Health Authorities (RHA). Policies and procedures regarding admission are the responsibility of each RHA. Following is the information from the Winnipeg Regional Health Authority:
- there are 6 emergency rooms and 1 urgent care centre (no acute inpatient beds) in the WRHA.
- prior to regionalization, some hospitals had automatic admit policies after a certain period of time. This no longer occurs.
- there is no common definition or criteria for the observation units. The WRHA is currently working on standardization of the policies throughout the ABC (Achieving Benchmarks through Collaboration) project.C. Current Observation Unit Admission Practices
The following table describes the current Observation Unit admission practices of Winnipeg hospitals.
Hospital Description of Practice
St. Boniface General Hospital Patients are under the care of the emergency physician. Admitted patients may be cohorted in observation.
Seven Oaks General Hospital Patients are admitted and under the care of a family physician / surgeon.
Grace General Hospital Patients are admitted under the care of a family physician. Some patients may be under the care of the emergency physician.
Health Sciences Center Patients are under the care of the emergency physician. Admitted patients may be cohorted in observation.
Victoria General Hospital Patients are admitted under the care of the family physician. Admitted patients may be cohorted under the internal medicine or surgery program.
Concordia Hospital Patients are admitted under the care of a family physician. Some patients may be under the care of the emergency physician.