Centers for Medicare and Medicaid Services (CMS). Medicare benefit policy manual, Chapter 6: Hospital services covered under Part B. Baltimore, MD: CMS; [revised Mar 1, 2013]. www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R42BP.pdf and www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c06.pdf (Accessed March 2016)Google Scholar

Ross, MA, Hockenberry, JM, Mutter, R, et al. Protocol-driven emergency department observation units offer savings, shorter stays and reduced admissions. Health Affairs 2013; 32(12): 2149–2156.CrossRefGoogle ScholarPubMed

Baugh, CW, Venkatesh, AK, Hilton, JA, et al. Making greater use of dedicated hospital observation units for many short-stay patients could save $3.1 billion a year. Health Affairs 2012; 31(10): 2314–2323.CrossRefGoogle ScholarPubMed

Macy, ML, Hall, M, Shah, SS, et al. Differences in designations of observation care in US freestanding Children’s Hospitals: are they virtual or real? J Hosp Medicine 2012; 7(4): 287–293.CrossRefGoogle ScholarPubMed

Mace, SE, Graff, L, Mikhail, M, et al. A national survey of observation units in the United States. Am J Emerg Med 2003 21:529–533.CrossRefGoogle ScholarPubMed

Osborne, A, Weston, J, Wheatley, M, et al. Characteristics of hospital observation services: a society of cardiovascular patient care survey. Critical Pathways in Cardiology 2013; 12(2): 45–48.CrossRefGoogle ScholarPubMed

Mace, SE, Shah, J. Observation medicine in emergency medicine residency programs. Acad Emerg Med 2002; 9: 169–171.CrossRefGoogle ScholarPubMed

Barsuk, J, Casey, D, Graff, L, et al. The Observation Unit: an operational overview for the hospitalist. Society of Hospital Medicine White Paper. May 21, 2009. www.hospitalmedicine.org/Content/NavigationMenu/Publications/WhitePapers/White_Papers.htm (Accessed March 2015)Google Scholar

Mace, SE. Pediatric observation medicine. Emerg Med Clinics North Am 2001: 19(1): 239–254.CrossRefGoogle ScholarPubMed

Ross, MA, Naylor, S, Compton, S, et al. Maximizing use of the emergency department observation unit: a novel hybrid design. Ann Emerg Med 2001; 37: 267–274.CrossRefGoogle ScholarPubMed

Zebrack, M, Kadish, H, Nelson, D. The pediatric hybrid observation unit: an analysis of 6477 consecutive patient encounters. Pediatrics 2005; 115(5): e535–e542.CrossRefGoogle ScholarPubMed

Mace, SE. Resuscitations in an observation unit. J Quality in Clinical Practice 1999; 19(3):155–163.CrossRefGoogle Scholar

Mace, SE. Patient complaints in an observation unit. J Quality Clinical Practice 1998; 18(2): 151–158.Google Scholar

Graff, LG, Wolf, S, Dinwoodie, R, et al. Emergency physician workload: a time study. Ann Emerg Med 1993: 22(7): 1156–1163.CrossRefGoogle ScholarPubMed

Maguire, P. What’s the ideal number of patients to see? Today’s Hospitalist, July 2009. Available on-line at: www.todayshospitalist.com/index.php?b=articles_read&cnt+824 (Accessed March 2016)Google Scholar

Sheehy, AM, Graf, B, Gangireddy, S, et al. Hospitalized but not admitted. Characteristics of patients with “Observation Status” at an academic medical center. JAMA Intern Med 2013; 173(2): 1991–1998.CrossRefGoogle Scholar

Medicare Payment Advisory Commission. A Data Book: Health Care Spending and the Medicare Program. June 2012. Section 7. www.medpac.gov/documents/Jun12dataBookEntireReport.pdf (Accessed March 2016)Google Scholar

Feng, Z, Wright, B, Mor, V. Sharp rise in Medicare enrollees being held in hospitals for observation raises concerns about causes and consequences. Health Aff (Millwood) 2012; 31(6): 1251–1259.CrossRefGoogle ScholarPubMed

MedPAC report to Congress: hospital inpatient and outpatient services. www.medpac.gov/documents/mar14_EntireReport.pdfchapters (Accessed March 2016)Google Scholar

MedPAC report to Congress: hospital inpatient and outpatient services. www.medpac.gov/chaptersMar13_Ch03.pdf (Accessed March 2016)Google Scholar

Centers for Medicare and Medicaid Services inpatient prospective payment system 1599-F. Fiscal year 2014 Final rule. www.gpo.gov/fdsys/pkg/FR-2013-08-19/pdf/2013-18956.pdf (Accessed March 2016)Google Scholar

Sheehy, AM, Caponi, B, Gangireddy, S, et al. Observation and inpatient status: clinical impact of the 2-midnight rule. Journal of Hospital Medicine 2014; 9(4): 203–209.CrossRefGoogle ScholarPubMed

www.healthcapital.com/hcc/newsletter/01_14/2-Midnight%20Rule.pdf (Accessed March 2016)Google Scholar

Society of Hospital Medicine Public Policy Committee. The Observation Status Problem. Impact and Recommendations for Change. Society of Hospital Medicine Whitepaper, July 2014. Available at www.hospital medicine.org/advocacy (Accessed March 2016)Google Scholar

www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-10-30-4.html (Accessed March 2016)Google Scholar

Centers for Medicaid and Medicare Services. CMS finalizes FY 2014 policy and payments changes for inpatient stays in acute-care and long-term care hospitals. www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-Sheets/2013-Fact-Sheets-Items/2013-08-02–2.html (Accessed March 2016)Google Scholar

Ross, MA, Hockenberry, JM, Barrett, M, et al. Protocol driven emergency department observation units offer savings, shorter stays and reduced admissions. Health Affairs 2013; 32(12): 2149–2156.CrossRefGoogle ScholarPubMed

Baugh, CW, Schur, JD. Observation care – high-value care or a cost-shifting loophole? New Engl J Med 2013; 369(4): 302–305.CrossRefGoogle ScholarPubMed

Baugh, CW, Venkatesh, AK, Hilton, JA, et al. Making greater use of dedicated hospital observation units for many short-stay patients could save $3.1 billion a year. Health Affairs 2012; 31(10): 2314–2322.CrossRefGoogle ScholarPubMed

Mace, SE, Graff, L, Mikhail, M, et al. A national survey of observation units in the United States. Am J Emerg Med 2003; 21: 529–533.CrossRefGoogle ScholarPubMed

Mace, SE, Shah, J. Observation medicine in emergency medicine residency programs. Acad Emerg Med 2002; 9:169–171.CrossRefGoogle ScholarPubMed

Graff, LG. Observation Medicine: The Healthcare System’s Tincture of Time. American College of Emergency Physicians Web site: www.acep.org/WorkArea?Download/Asset.aspx?id=45885 (Accessed March 2016)Google Scholar

Venkatesh, AK, Geisler, P, Gibson Chambers, JJ, et al. Use of observation care in US emergency departments, 2001 to 2008. PLos ONE 2011; 6(9):1–10 (e24326).CrossRefGoogle ScholarPubMed

Baugh, CW, Venkatesh, AK, Bohan, JS. Emergency department observation units: a clinical and financial benefit for hospitals. Health Care Manage Rev 2011; 36(1): 28–37.CrossRefGoogle ScholarPubMed

Osborne, A, Weston, J, Wheatley, M, et al. Characteristics of hospital observation services: A Society of Cardiovascular Patient Care survey. Critical Pathways in Cardiology 2013; 12(2): 45–49.CrossRefGoogle ScholarPubMed

Department of Health and Human Services (DHHS) Centers for Medicare and Medicaid Services (CMS). CMS Manual System Pub. 100-02 Medicare Benefit Policy. Transmittal 42. Date: December 16, 2005. Available at www.cms.gov/Regulations-and-Guidance/Transmittals/downloads/R42BP.pdf (Accessed March 2016)Google Scholar

Sheehy, AM, Caponi, B, Ganigreddy, S, et al. Observation and inpatient status: clinical impact of the 2-midnight rule. J Hosp Med 2014; 9(4): 203–209.CrossRefGoogle ScholarPubMed

Centers for Medicare and Medicaid Services Hospital inpatient prospective payment system 1599-F. Fiscal year 2014 Final rule. Federal register/Vol. 78, No.160/Monday, August 19, 2013/Rules and Regulations. www.gpo.gov/fdsys/pkg/FR-2013-18956.pdf (Accessed March 2016)Google Scholar

Don’t ignore the two-midnight rule. It’s still in effect. Hosp Case Manag 2014; 22(5): 57–66.Google Scholar

CMS announces delay in two-midnight rule enforcement. Hosp Peer Rev 2014; 39(4): 37–38.Google Scholar

www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-Review/InpatientHospitalReviews.html) (Accessed March 2016)Google Scholar

Carlson, J. Auditing inpatient stays. “Two-midnight” rule may still prove costly. Mod Healthc 2013 September 9; 43(36):9–10.Google ScholarPubMed

Is the two-midnight rule much ado about nothing? Hosp Case Manag 2013 December; 21(12): 161–164.Google Scholar

Egusquiza, D. 8 critical steps for 2-midnight compliance. Healthc Financ Manage 2014 February; 68(2): 54–57.Google ScholarPubMed

Edelberg, C. A. closer look at the two-midnight rule, what it means for ED providers. ED Manag 2013 December; 25(12): 142–143.Google Scholar

Cesta, T. Case management insider. The 2-midnight rule – a game changer for case management. Hosp Case Manag 2014 April; 22(4): 47–50.Google Scholar

www.cms.gov/Outreach-and-Education/Outreach/NPC/National-Provider-Calls- and-Events.html (Accessed March 2016)Google Scholar

PEPPER can help you focus on likely RAC targets. Hospital Case Management; 2010 December; 18(12): 181–182.Google Scholar

PEPPER can identify areas where denials may occur. Hospital Case Management; 2005 June; 13(6): 84–86.Google Scholar

http://store.relearning.com/by-topic/pepper-1/pepper.html (Accessed March 2016)Google Scholar

Wiedemann, LA. Seasoning your compliance plan with PEPPER. How to read PEPPER data on payment errors; 2007 January; 78(1): 44–49.Google ScholarPubMed

www.hcpro.com/print/HOM-218293–5750/What-is-PEPPER-data-and-how-can -it-help-prepare-for-a-RAC-audit? (Accessed March 2016)Google Scholar

TMF Health Quality Institute http://pepperresourcs.org/PEPPER/SecurePEPPERAccess.aspx ( Accessed March 2016)Google Scholar

Kulus, J. PEPPER gives corporate compliance guidelines. Provider: Long Term & Post-Acute Care. 2013 March; www.providermagazine.com/archives/2014_Archives/Pages/0314 (Accessed March 2016)Google Scholar

TMF health Quality Institute http://hospitals.tmf.org/PEPPERResources/tabid/1115/Default.aspx (Accessed March 2016)Google Scholar

www.hcpro.com/HIM-245049–865/Use-PEPPER-reports-to-stay-on-top-of-common-coding-errors (Accessed March 2016)Google Scholar

Corrati, RR. Report data identify risk areas for improper payments. Healthcare Financial Management 2011 October; 65(10): 88–92.Google Scholar

Report on Medicare Compliance: PEPPER compliance tool is revised for two-midnight rule in time for June release. Atlantic Information Services, Inc. 2014 May; 23(16). Available online at www.AIShealth.com (Accessed March 2016)Google Scholar

Centers for Medicare and Medicaid Services. www.cms.gov/Medicare/medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2014-IPPS-FinalRule (Accessed March 2016)Google Scholar

www.ngsmedicare.com/ngs/portal/ngsmedicare (Accessed March 2016)Google Scholar

www.careguidelines.com (Accessed 2016)Google Scholar

www.mckesson.com/about-mckesson/our-company/businesses/mckesson-health-solutions/interqual-evidence-based-clinical-content (Accessed 2016)Google Scholar

Mitus, AJ. The birth of interqual. Professional Case Management 2008; 13(4): 228–233.CrossRefGoogle ScholarPubMed

www.acep.org/Clinical–Practice-Management/Utilization-Review-FAQ (Accessed March 2016)Google Scholar

McKendry, MJ, Van Horn, J. Tips, tools and techniques. Case Management 2004; 9(2): 61–71.Google Scholar

Wang, H, Robinson, RD, Coppola, M, et al. The accuracy of interqual criteria in determining the need for observation versus hospitalization in emergency department patients with chronic heart failure. Critical Pathways in Cardiology 2013; 12(4): 192–196.CrossRefGoogle ScholarPubMed

Irwin, CB, Nigl, J, Lowe, RA. Accuracy of interqual criteria in determining the hospitalization need in medicare patients with gastrointestinal bleeding. Acad Emerg Med 2000; 7:552–553 (abstract).Google Scholar

Irvin, CB, Monfette, K, Lowe, R. Retrospective evaluation of potential Medicare admission denials using interqual and Milliman Roberts admission criteria. Acad Emerg Med 2000; 7:543 (abstract).Google Scholar

Rutledge, R. An analysis of 25 Milliman & Robertson guidelines for surgery: data driven versus consensus-derived clinical practice guidelines. Ann Surg 1998; 228(4): 579–585.CrossRefGoogle ScholarPubMed

www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R299CP.pdf (Accessed March 2016)Google Scholar

www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE0622.pdf (Accessed 2016)Google Scholar

Confusion ahead as CMS changes inpatient criteria. Hospital Case Management 2013 October; 21(10): 133–136.Google Scholar

www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html (Accessed March 2016)Google Scholar

www.cdc.gov/nchs/icd/icd9.htm (Accessed March 2016)Google Scholar

http://cms.gov/Medicare/Coding/ICD10/index.html (Accessed March 2016)Google Scholar

www.cdc.gov/nchs/icd/icd10cm.htm (Accessed March 2016)Google Scholar

ICD-9-CM (International Classification of Diseases 9th Revision Clinical Modification). Hart, AC, Stegman, MS, Ford, B (eds.) Optum Insight, Inc., 2012, sixth ed.Google Scholar

ICD-10-CM. Official Guidelines for Coding and Reporting –Fy 2015. Department of Health and Human Services, 2015. ,Google Scholar

Gabber, W, Kachur, KH, Canter, KV. Current Procedural Coding Expert: CPT Codes with Medicare Essentials Enhanced for Accuracy. American Medical Association, 2011.Google Scholar

www.medicare.gov/what-medicare-covers/part-a/what-part-a-covers.html (Accessed March 2016)Google Scholar

www.medicare.gov/what-medicare-covers/part-b/what-medicare-part-b-covers.html (Accessed march 2016)Google Scholar

www.acep.org/Clinical–Practice-Management/Utilization-Review-FAQ (Accessed March 2016)Google Scholar

www.cms.gov/apps/er_report/preview_er_report.asp?from=public&which=long&reportid=7&tab=3/ (Accessed March 2016)Google Scholar

www.pepperresources.org (Accessed March 2016)Google Scholar

www.primaris.org/sites/default/files/resources/HPMP/hpmp%20info%20sheet.pdf (Accessed March 2016)Google Scholar

www.acep.org/Clinical–Practice-Management/Utilization-Review-FAQ (Accessed March 2016)Google Scholar

Sheely, AM, Graf, B, Gangireddy, S, et al. Characteristics of patients with “observation status” at an academic medical center. JAMA Intern Med 2013; 173(21): 1991–1998.Google Scholar

Centers for Medicare and Medicaid Services. Are you a hospital inpatient or outpatient? www.medicare.gov/publications/pubs/pdf/11435.pdf (Accessed March 2016)Google Scholar

Centers for Medicare Advocacy Inc. Observation status. www.medicareadvocacy.org/medicare-info/observation-status#definition (Accessed March 2016)Google Scholar

Medicare Benefit Policy Manual. Chapter 6: Hospital Services Covered Under Part B. 20.5 –Outpatient Observation Services. www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf (Accessed March 2016)Google Scholar

Baugh, CW, Schuur, JD. Observation care – high-value care or a cost-shifting loophole? N Engl J Med 2013; 369(4): 302–305.CrossRefGoogle ScholarPubMed

Society of Hospital Medicine Public Policy Committee. The Observation Status Problem. Impact and Recommendations for Change. Society of Hospital Medicine Whitepaper, July 2014. Available at www.hospital medicine.org/advocacy (Accessed March 2016)Google Scholar

Lee, TH, Cook, EF, Rouan, GW, Weisberg, MC, Goldman, L. Ruling out myocardial infarction: prospective multicenter validation of a 12 hour strategy for low risk patients. Clinical Research 1989; 37:524A.Google Scholar

Karcz, A, et al. Massachusetts emergency medicine closed malpractice claims: 1988–1990. Ann Emerg Med 1993; 22:553.CrossRefGoogle ScholarPubMed

Pope, JH, Aufderheide, TP, Ruthazer, R, et al. Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med 2000; 342:1163–70.CrossRefGoogle ScholarPubMed

Murphy, DG, Zalenskio, RJ, Raucci, JC et al. The utility of extended emergency department treatment of asthma. Ann Emerg Med 1989; 8:467.CrossRefGoogle Scholar

Graff, LG, Dallara, J, Ross, MA, et al. Impact on the care of the emergency department chest pain patient from the Chest Pain Evaluation Registry (CHEPER) study. Am J Cardiol 1997; 80:563–568.CrossRefGoogle ScholarPubMed

Rydman, RJ, Isola, ML, Roberts, RR, et al. Emergency Department Observation Unit versus hospital inpatient care for a chronic asthmatic population: a randomized trial of health status outcome and cost. Med Care. 1998; 36:599–609.CrossRefGoogle ScholarPubMed

Roberts, R, et al. A randomized clinical trial of inpatient versus observation care in the evaluation and management of chest pain patients. JAMA 1997; 278:1670–1676.CrossRefGoogle Scholar

American College Emergency Physicians. Emergency Department Observation Units. Ann Emerg Med 1988; 17:95–96.CrossRefGoogle Scholar

American College Emergency Physicians Practice Management Committee. American College Emergency Physicians. Management of Observation Units. Ann Emerg Med 1988; 17:1348–1352.CrossRefGoogle Scholar

Brillman, J, Dunbar, L, Graff, L, et al. American College of Emergency Physicians Section of Observation Services: management of observation units. Ann Emerg Med 1995; 25:823–830.CrossRefGoogle Scholar

Ross, MA, Aorora, T, Graff, LG, Suri, P, Ojo, A, Bohan, S, Clark, C, O’Malley, R. State of Art: Emergency Department Observation Unit. Critical Pathways in Cardiology 2012; 11(3):128–138.CrossRefGoogle Scholar

Graff, LG (Editor in Chief). Observation Medicine: The Healthcare System’s Tincture of Time. Online Textbook of the American College of Emergency Physicians Observation Medicine Section at www.acep.org/acepmembership.aspx?id=30260Google Scholar

Graff, LG, Dunbar, L, Gibler, B, Goldfrank, L, Leikin, J, Severance, H, Schultz, C, Yealy, D, Watkins, R, Zun, L. Observation Medicine: an annotated bibliography. Amer J Emerg Med 1992; 10:84–93.CrossRefGoogle ScholarPubMed

Graff, LG, Dunbar, L, Gibler, WB, et al. Observation Committee of the Society of Academic Emergency Medicine. Observation medicine curriculum. Ann Emerg Med 1992; 21:963–966.CrossRefGoogle Scholar

Graff, LG, Zun, L, Leiken, J, Gibler, WB, et al. Observation Committee of the Society for Academic Emergency Medicine. Emergency department observation beds improve patient care: Society for Academic Emergency Medicine debate. Ann Emerg Med 1992; 21:967–975.CrossRefGoogle Scholar

Ross, M, Graff, L (eds.). Principles of observation medicine. Emerg Med Clin North Am 2001; 19.CrossRefGoogle ScholarPubMed

Graff, LG (ed.). Observation Medicine. Butterworth-Heinemann, Stoneham, MA, 1993.Google Scholar

Graff, LG (ed.). Observation Units: Implementation and Management Strategies. American College of Emergency Physicians, Dallas, TX, 1998.Google Scholar

Gomez, M. An emergency department based protocol for rapidly ruling out myocardial ischemia reduces hospital time and expense: Results of a randomized study (ROMIO). J Am Coll Cardiol 1996; 28:25–33.CrossRefGoogle ScholarPubMed

Farkouh, ME, Smars, PA, Reeder, GS, et al. A clinical trial of a chest-pain observation unit for patients with unstable angina. N Engl J Med 1998; 339:1882–1888.CrossRefGoogle ScholarPubMed

Goodacre, S, et al. Randomised controlled trial and economic evaluation of a chest pain observation unit compared with routine care. Br Med J 2004; 328:254–264.CrossRefGoogle ScholarPubMed

McDermott, , et al. Treatment of acute asthma patients as outpatients in an observation unit versus as an inpatient in the hospital. Arch Int Med 1997; 157:2055–2062.CrossRefGoogle Scholar

Decker, WW, et al. A prospective, randomized clinical trial of an emergency department observation unit for acute atrial fibrillation. Ann Emerg Med 2008; 52:322–328.CrossRefGoogle Scholar

Shen, W, Beinborn, D. Random clinical trial of observation unit versus in patient services in evaluation and management of patients with syncope. EP Lab Digest May 2005.Google Scholar

Ross, M, et al. An emergency department management protocol for patients with Transient Ischemic Attacks: a randomized clinical trial. Ann Emerg Med 2007.Google Scholar

Graff, LG, Clark, S. Emergency physician critical care services: a time study at an American and an English Emergency Department. Arch Emerg Med 1993; 10:145–154.CrossRefGoogle Scholar

Graff, LG (ed.). Observation Medicine. Butterworth-Heinemann, Stoneham, MA, 1993.Google Scholar

Graff, LG (Editor in Chief). Observation Medicine: the Healthcare System’s Tincture of Time. Online Textbook of the American College of Emergency Physicians Observation Medicine Section at www.acep.org/acepmembership.aspx?id=30260Google Scholar

Brillman, J, Dunbar, L, Graff, L, et al. American College of Emergency Physicians Section of Observation Services: management of observation units. Ann Emerg Med 1995; 25:823–830.CrossRefGoogle Scholar

Ross, MA, Aorora, T, Graff, LG, et al. State of art: emergency department observation unit. Critical Pathways in Cardiology 2012; 11(3):128–138.CrossRefGoogle Scholar

Graff, LG, Dallara, J, Ross, MA, et al. Impact on the care of the emergency department chest pain patient from the Chest Pain Evaluation Registry (CHEPER) study. Am J Cardiol 1997; 80:563.CrossRefGoogle ScholarPubMed

Goodacre, S, Nicholl J, Dixon S, et al. Randomised controlled trial and economic evaluation of a chest pain observation unit compared with routine care. Br Med J 2004; 328:254.CrossRefGoogle ScholarPubMed

Roberts, RR, Zalenski, RJ, Mensah, EK, et al. Costs of an emergency department-based accelerated diagnostic protocol vs hospitalization in patients with chest pain: a randomized controlled trial. JAMA 1997; 278:1670–1676.CrossRefGoogle ScholarPubMed

Rydman, RJ, Isola, ML, Roberts, RR, et al. Emergency department observation unit versus hospital inpatient care for a chronic asthmatic population: a randomized trial of health status outcome and cost. Med Care 1998; 36:599–609.CrossRefGoogle ScholarPubMed

Roberts, RR, Zalenski, RJ, Mensah, EK, et al. Cost of an emergency department-based accelerated diagnostic protocol vs. hospitalization in patients with chest pain: a randomized controlled trial. JAMA 1997; 278:1670–1676.CrossRefGoogle ScholarPubMed

McDermott, M, Murphy, D, Zalenski, R, et al. A comparison between emergency department diagnostic and treatment unit and inpatient care in the management of acute asthma. Arch Intern Med 1997; 157:2055–2062.CrossRefGoogle ScholarPubMed

American College of Emergency Physicians. Emergency department observation units. Ann Emerg Med. 1988; 17:95–96.CrossRefGoogle Scholar

American College of Emergency Physicians. Management of Observation Units [policy resource and education paper]. Approved January 2008. www.acep.org (Accessed February 20, 2016)Google Scholar

Baugh, CW, Venkatesh, AK, Bohan, JS. Emergency department observation units: A clinical and financial benefit for hospitals. Health Care Management Review. 2011; 36(1):28–37CrossRefGoogle ScholarPubMed

Ross, MA, Naylor, A, Compton, S. Maximizing use of the emergency department observation unit: A novel hybrid design. Ann Emerg Med. 2001; 37(3):267–274.CrossRefGoogle ScholarPubMed

Graff, LG, Dallara, J, Ross, MA, et al. Impact on the care of the emergency department chest pain patient from the Chest Pain Evaluation Registry (CHEPER) study. American J Cardiology. 1997; 80:563–568.CrossRefGoogle ScholarPubMed

Sieck, S. Cost effectiveness of chest pain units. Cardiol Clin. 2005; 23:589–599.CrossRefGoogle ScholarPubMed

Robinson, D, Woods, P, Snedecker, C, et al. A comparison trial for stratifying intermediate risk chest pain: Benefits of emergency department observation centers. Preventive Cardiol. 2002; 5:23–30.CrossRefGoogle ScholarPubMed

Roberts, R, Graff, L. Economic issues in observation unit medicine. Emer Med Clinics of N America. 2001; 19(1):19–33.CrossRefGoogle ScholarPubMed

Graff, LG. In Observation Medicine, The Healthcare System’s Tincture of Time. Update August 2011. Retrieved March 28, 2012, from American College of Emergency Physicians website: www.acep.org/Workarea/DownloadAsset.aspx?id=45885 (Accessed February 20, 2016)Google Scholar

American College of Emergency Physicians. Chest Pain Units in Emergency Departments. A report from the Short Term Observation Services Section. Aug. 8, 1994. www.acep.org (Accessed February 20, 2016)Google Scholar

Mace, SE, Graff, L, Mikhail, M, et al. A national survey of observation units in the United States. Amer J Emerg. Med 2003; 21(7):529–533.CrossRefGoogle ScholarPubMed

Robinson, DJ. Hospital based observation unit design. In Observation Medicine, The Healthcare System’s Tincture of Time. Update August 2011. Retrieved March 28, 2012, from American College of Emergency Physicians website: www.acep.org/Content.aspx?id=46142&terms=observation (Accessed February 20, 2016)Google Scholar

Cooke, MW, Higgins, J, Kidd, P. Use of emergency observation and assessment wards: A systematic literature review. Emerg Med J. 2003; 20:138–142.CrossRefGoogle ScholarPubMed

Huddy, J. In: Huddy, J, ed. Emergency Department Design; A Practical Guide to Planning for the Future. Dallas, TX: American College of Emergency Physicians; 2002.Google Scholar

Graff, LG. Observation unit staffing. In Graff, LG, ed. Observation Medicine. Newton, MA: Butterworth-Heinemann; 1993:89–98.Google Scholar

Emergency Nurses Association. Observation Units/Clinical Decision Units. [Position Statement]. Revised Sept 1997.Google Scholar

Brillman, J, Mathers-Dunbar, L. American College of Emergency Physicians: Management of observation units. Ann Emerg Med. June 1995; 25:823–830.CrossRefGoogle ScholarPubMed

Rotter, T, Kugler, J, Koch, R, et al. A systematic review and meta-analysis of clinical pathways on length of stay, hospital costs and patient outcomes. BMC Health Services Research. 2008; 8 (265): 1–15. www.biomedcentral.com/472–6963/8/265 (Accessed February 20, 2016)CrossRefGoogle ScholarPubMed

Crenshaw, LA, Lindsell, CJ, Storrow, AB, et al. An evaluation of emergency physician selection of observation unit patients. Am J Emerg Med 2006 May;24(3):271–279.CrossRefGoogle ScholarPubMed

Burkhardt, J, Peacock, WF, Emerman, CL. Predictors of emergency department observation unit outcomes. Acad Emerg Med 2005 Sep;12(9):869–874.CrossRefGoogle ScholarPubMed

Ross, MA, Compton, S, Richardson, D, et al. The use and effectiveness of an emergency department observation unit for elderly patients. Ann Emerg Med 2003 May;41(5):668–677.CrossRefGoogle ScholarPubMed

Brillman, J, Mathers-Dunbar, L, Graff, L, et al. Management of observation units. American College of Emergency Physicians. Ann Emerg Med 1995 Jun;25(6):823–830.CrossRefGoogle ScholarPubMed

Greene, J. Nurse groups, administrators battle over mandatory nursing ratios: California law debated on national stage. Ann Emerg Med 2009 September;54(3):31–33.CrossRefGoogle Scholar

Baugh, CW, Venkatesh, AK, Bohan, JS. Emergency department observation units: A clinical and financial benefit for hospitals. Health Care Manage Rev 2011 Jan–Mar;36(1):28–37.CrossRefGoogle ScholarPubMed

Centers for Medicare & Medicaid Services (CMS). CMS Manual System: Pub 100-04 Medicare Claims Processing. 2008 February 22nd; Transmittal 1466.Google Scholar

Mace, SE, Graff, L, Mikhail, M, et al. A national survey of observation units in the United States. Am J Emerg Med 2003 Nov;21(7):529–533.CrossRefGoogle ScholarPubMed

Mace, SE, Graff, L, Mikhail, M, et al. A national survey of observation units in the United States. Am J Emerg Med 2003; 21: 529–533.CrossRefGoogle ScholarPubMed

Mace, SE. Resuscitations in an observation unit. Journal of Quality in Clinical Practice 1999; 19(3):155–164.CrossRefGoogle Scholar

Henry, G. Emergency Medicine Risk Management: A Comprehensive Review, 2nd ed. American College of Emergency Physicians, Dallas, TX, 2001.Google Scholar

Deming, WE. Out of Crisis. Massachusetts Institute of Technology, Center for Advanced Engineering Study, Cambridge, MA, 1982.Google Scholar

Rogers, JT. Risk Management in Emergency Medicine. American College of Emergency Physicians, Dallas, TX, 1985.Google Scholar

Ibid.Google Scholar

Henry, G. Headache, Emergency Medicine Concepts in Clinical Practice, 4th ed. Rosen/Barkan et al., C.V. Mosby-Yearbook Inc., St. Louis, MO, 1998.Google Scholar

Butz, AM. Outcomes of emergency room treatment of children with asthma. J Asthma. 1991;28(4):255.CrossRefGoogle ScholarPubMed

Batalden, PB, Nelson, EC, Gardent, PB, et al. Leading macrosystems and mesosystems for microsystem peak performance. In: Nelson, EC, Batalden, PB, Godfrey, MM (eds). Quality by Design. San Francisco, CA, Josey-Bass, 2007; ch. 4, pp. 69–105.Google Scholar

Francis, RCE, Spies, CD, Kerner, T. Quality management and benchmarking in emergency medicine. Curr Opin Anesthesiol, 2008; 21: 233–239.CrossRefGoogle ScholarPubMed

Specific Aims. In: Nelson, EC, Batalden, PB, Godfrey, MM (eds). Quality by Design. San Francisco, CA, Josey-Bass, 2007; ch. 18, pp. 308–312.Google Scholar

Blumenthal, D. Performance improvement in health care – seizing the moment. N Engl J Med, 2012; 366(21): 1953–1955.CrossRefGoogle ScholarPubMed

Mace, SE. Patient quality (continuous quality improvement), safety and experience for the observation unit. In: Observation Medicine. American College of Emergency Physicians, www.acep (Accessed March 20162012).Google Scholar

Glickman, SW, Schulman, KA, Peterson, ED, et al. Evidence-based perspectives on pay for performance and quality of patient care and outcomes in emergency medicine. Ann Emerg Med, 2008; 51: 622–631.CrossRefGoogle ScholarPubMed

Baker, WE. Evaluation of clinical performance in emergency medicine. Emerg Med Clin N Am, 2009; 27: 615–626.CrossRefGoogle ScholarPubMed

Langberg, ML, Black, JT. Dead souls comparing Dartmouth atlas benchmarks with CMS outcomes. N Engl J Med, 2009; 361(122):e109.CrossRefGoogle ScholarPubMed

Wachter, RM. The nature and frequency of medical errors and adverse events. In: Wachter, RM. Understanding Patient Safety. New York: McGraw Hill, 2008; ch. 1, pp. 3–16.Google Scholar

Hudson, S. Patient experience: How to get the journey right from start to finish. Health Service Journal, March 29, 2012; 122 (6300): 28–29.Google ScholarPubMed

Glasgow, JM, Scott-Caziewell, J, Jill, R, et al. Guiding inpatient quality improvement: a systematic review of lean and six sigma. Jt. Comm J Qual Patient Safety, Dec 2010; 36(12): 531–532.Google ScholarPubMed

Graff, L. Observation units for elimination of missed myocardial infarction errors. Maryland Medicine, 2001; suppl; 40–42.Google Scholar

Mace, SE. Continuous quality improvement for the clinical decision unit. Healthcare Quality, 2004; 26(1): 29–36.CrossRefGoogle ScholarPubMed

Mace, SE. An analysis of patient complaints in an observation unit. J Qual Clin Practice, 1998; 18(2): 151–158.Google Scholar

Mace, SE. Resuscitations in an observation unit. J Qual Clin Practice, 1999; 19: 155–164.CrossRefGoogle Scholar

Donabedian, A. The quality of care: How can it be measured. JAMA, 1988; 121(11): 1145–1150.Google Scholar

Graff, LG, Dallara, J, Ross, MA, et al. Impact on the care of the emergency department chest pain patient evaluation registry (CHEPER) study. Amer J Card 1997; 80(5): 563–568.CrossRefGoogle ScholarPubMed