Direct Visual Observation Required in Emergency Department

Q: If an Emergency Department is greater than 7500 square feet but less than 10,000 square feet and is deemed to have “sleeping accommodations”, do the requirements of direct visual observation per 19.2.5.7.2.1(D)(1)(a) apply since only “sleeping accommodations” are provided and not a full “patient sleeping room”?

A: According to CMS, the answer is yes. They consider an Emergency Department that provides observation beds to be sleeping accommodations and must comply with healthcare occupancy sleeping suite requirements, and all that is required. They also consider the patient as ‘inpatients’, which seems to be contrary to the what the rest of the world believes.

See if you can do one of the following:

  • Eliminate the ‘observation beds’
  • Relocate those ‘observation beds’ to a regular inpatient unit
  • Divide your ED up into multiple suites to get around the direct observation requirement for sleeping suites over 7500 square feet.