Implementing a Second-Level Observation Unit at a Large Academic Medical Center

Authors: Padageshwar R. Sunkara, MD, MMCi, William C. Lippert, MD, MPH, Gary E. Rosenthal, MD, Brian C. Hiestand, MD, John Blalock, MHA, Chi C. Huang, MD


The two-midnight rule, 30-day readmission penalties, and denials related to short-stay hospitalizations have led to the creation of alternative healthcare delivery models.1 As a result, during the last 2 decades, there has been an increase in the number of observation units (OUs) across the United States to care for those patients who do not meet inpatient criteria, but have needed further workup and were expected to be discharged within 48 hours.2,3

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