Inpatient vs Observation Calculator — Two-Midnight Decision Tool

1. Working diagnosis

Pick one or more. Each loads its validated tool — and only the fields that tool needs. Enter a value once (vitals, labs) and every other tool reuses it.

Cardiac

Chest pain — ACS risk (HEART)Acute heart failure — ED risk (Ottawa/OHFRS)Syncope — serious-outcome risk (San Francisco Rule)Syncope — 30-day risk (Canadian Syncope Risk Score)

Pulmonary

Pneumonia — severity (CURB-65)Pneumonia — 30-day mortality (PSI/PORT)Suspected PE — rule-out (PERC)Confirmed PE — 30-day mortality (sPESI)COPD exacerbation — mortality (DECAF)Suspected PE — pretest probability (Wells)

Infectious / sepsis

Suspected sepsis — bedside (qSOFA)Sepsis — organ dysfunction (SOFA)Systemic inflammatory response (SIRS)

Neurologic

TIA — early stroke risk (ABCD²)Ischemic stroke — severity (NIHSS)Intracerebral hemorrhage — mortality (ICH Score)

General

General deterioration — track & trigger (NEWS2)

Endocrine / metabolic

DKA — severity (ADA)Hyperosmolar hyperglycemic state (HHS)

Gastrointestinal

Upper GI bleed — risk (Glasgow-Blatchford)Upper GI bleed — pre-endoscopy risk (Rockall)Upper GI bleed — mortality (AIMS65)Acute pancreatitis — mortality (BISAP)

Hepatic

End-stage liver disease — mortality (MELD)

2. Two-Midnight benchmark

CMS 42 CFR 412.3 — the anchor for inpatient status.

Planned procedure is on the CMS Inpatient-Only list (forces inpatient)

3. Severity & intensity

Optional supporting markers.

Severity of illnessIntensity of service

Inpatient vs observation — FAQ

What is the Two-Midnight Rule?

A CMS benchmark (42 CFR 412.3): if a clinician expects a patient to require medically necessary hospital care spanning at least two midnights, inpatient admission is generally appropriate; otherwise observation is usually the right status.

How does this inpatient vs observation calculator work?

You pick one or more working diagnoses and enter the pertinent vitals, labs, and findings — each datum just once, shared across every relevant validated tool (HEART, CURB-65, qSOFA, ABCD², Wells, NEWS2, Glasgow-Blatchford, and more). Set your Two-Midnight expectation and flag any Inpatient-Only procedure, and it returns a recommendation, a confidence score, and a supporting-evidence note for documentation.

Is any patient information stored?

No. All computation runs in your browser — no patient-identifying fields are collected, and nothing clinical is sent to or logged on a server.

Is this a substitute for clinical judgment?

No. It is decision support for licensed clinicians. The admission decision and its documentation remain the treating clinician’s responsibility.