When patients are admitted to the hospital, they can be admitted as one of three levels – under observation, inpatient or outpatient.

A patient’s level of care is determined by the amount and type of care they need, as well as their existing health conditions.

“It can be difficult for a patient to anticipate which level of care they’ll end up needing as each situation is different, but providers ensure the level of care matches the patient’s needs,” said Carrie Brown, a registered nurse and care manager at UCHealth Yampa Valley Medical Center. Brown outlines the different levels of care below.

Observation

If you’re admitted under observation, that means providers are working to diagnose the issue.

“When someone’s admitted under observation, we’re trying to figure out what’s wrong. Providers are doing tests, and it’s more of the searching phase,” Brown said.

Depending on what is discovered, a patient may be released from the hospital or may be upgraded for inpatient care.

Inpatient

When a patient is considered inpatient, it means their health situation is more serious and requires a higher intensity of care. For instance, patients who had a major surgery that requires monitoring, who are dealing with complex medical situations, or who have experienced a life-threatening emergency situation will likely be admitted to inpatient care.

“You’ve moved past trying to figure out what’s wrong and you’re actively treating something like a stroke, a heart attack, a burn,” Brown said. “There’s a lot of nursing care and medical care around the clock.”

Most inpatient stays involve at least one overnight stay, but patients can be discharged at any time.

Outpatient

Patients may also be at the hospital for outpatientcare, which requires less intense care and lasts less than a full day.

“You may come in for a colonoscopy or a minor surgery, you may go to a patient room or the patient care unit, and you may even stay overnight, but it’s still considered outpatient because less intense nursing care is needed and you’re not there more than 24 hours,” Brown said.

Receiving outpatient care is an integral step after a minor surgery, as it ensures patients are safe to go home.

“People have to wake up enough from anesthesia, we have to treat their pain, we have to make sure they can drink something and not be nauseated,” Brown said. “We want to get them back to baseline before they’re able to go home.”

Changing levels

If a patient’s needs change, they may be changed to a different level of care. For instance, a patient might come in for a joint replacement and start off in observation, then if providers realize the patient needs more care and time before being released, the patient might be changed to inpatient care.

A utilization management team regularly reviews patient charts, diagnoses and treatments, to help ensure patients are getting the appropriate level of care for their conditions.

After the stay

When a patient no longer needs hospital care, they are released. Most patients head home, but some might head to a short-term rehabilitation facility.

“If someone is inpatient and the physicians, physical therapists and occupational therapists agree they’re not quite ready to be safe at home, a short-term rehab situation is usually recommended,” Brown said. “Most people go for two to three weeks and then go home. It’s a nice stepping stone.”

Brown notes that Medicare coverage can have some nuances. For instance, Medicare usually covers inpatient stays but might only cover 80% of the stay if a patient is under observation. Also, patients need three “midnights” or overnight stays in the hospital to qualify under Medicare for care at a skilled nursing facility.

Brown encourages patients to understand how their chosen plan works, and points out that most patients have supplemental coverage for items Medicare doesn’t cover.

“It can be confusing, but you can use local resources, such as the Routt County Council on Aging, to learn more,” Brown said.

Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at cunninghamsbc@gmail.com.