1. Case managers can play a key role in correct assignment of patient status through the use of the CMAP. 2. Hospitals that were successful in implementing the protocol had highly involved senior management, stable corporate environments, physician buy-in, physician champions, policies for mandatory use within the facilities, support from all team members, and "out-of-the-box" thinking for case management coverage. 3. Staffs at hospitals that implemented the protocol indicate they are well positioned for the Recovery Audit Contractor program, which began as a 3-year demonstration project and is now being implemented. It will be in place nationally by 2010.

1. Although outpatient observation admission status has been around for many years, there remain confusion and resistance to its use. The definitions of clinical status, level of care, and patient status are not well defined, and choosing the correct pathway for each patient can be complex. This article helps clarify "Observation vs. Inpatient"admission status and details lessons learned in reducing resistance. 2. Use of the case management protocol requires a hospital to define case management roles and responsibilities. This is a critical but often neglected task. 3. Use of case management for determining correct patient status is growing. With new Centers for Medicare & Medicaid Services initiatives, including the recovery audit contractors, case management is a viable solution to maintaining the fiscal health of hospitals.

Feedback on performance, coupled with proactive collaboration with emergency department staff, resulted in improved compliance with the stroke guidelines.