Distribution of Time Documented as Spent on Observation Unit Disposition Process

IntroductionEmergency Department (ED) Observation Units (OUs) are increasingly-common. Centers for Medicare and Medicaid Services (CMS) reimbursement policies incentivize documenting longer times spent on the disposition/discharge process ([&ge;]31 minutes). In addition, there is a well-recognized phenomenon of "terminal digit preference (ending times in 0 or 5). The Long Island Jewish Medical Center (LIJ) EDs OU disposition process is performed by physician assistants (PAs). This study investigates the distribution of times documented by OU PAs as being spent on disposition and whether those times indicate terminal digit preference. MethodsDocumentation for discharge times of 102 patients dispositioned from the LIJ ED OU were captured, along with the PA involved. Students T-test was used to compare percentages. Statistical significance was set a priori at p <0.05. ResultsSeven PAs entered discharge times for 102 patients. No times were documented as <31 minutes. Time documented by PAs demonstrated significant clustering (ie, each PA was very consistent in the amount of time they documented). Nearly 50% of times were documented as "35 minutes." Almost the entire remainder of times (46.1%) were documented as exactly 31 minutes or within 2 minutes of that (ie, 31, 32, or 33 minutes). Slightly over 50% of times documented ended in a "0" or a "5," statistically-significantly greater than the expected 20% (p <0.0001). DiscussionDocumentation of most times being at or just slightly greater than 31 minutes suggests that documentation may reflect CMSs reimbursement incentives. Over half of times documented ended in 0 or 5, indicating "terminal digit preference." Further research is needed to confirm these findings and analyze the impact of CMS policy changes on in healthcare documentation.