Thank you for your question regarding CMS871v4, Hospital Harm - Severe Hyperglycemia. For this measure, the inpatient hospitalization period includes time in emergency department (ED) and/or observation status when the transition between discharge from these encounters and admission to the inpatient encounter is one hour or less. Using the example you provided, if the patient is discharged from the observation encounter at 17:15 and is admitted to the inpatient encounter at 18:00, then the inpatient hospitalization period assessed by the measure would begin at 8:00 on January 1, 2025 (the ED encounter start time), as the transition between discharge from the observation encounter and the start of the inpatient encounter is less than one hour, and the ED encounter immediately preceded the observation encounter. If the patient is discharged from the observation encounter at 12:00 and is admitted to the inpatient encounter at 18:00, then the inpatient hospitalization period assessed by the measure would begin at 18:00 on January 1, 2025 (the inpatient encounter start time), as the transition between discharge from the observation encounter and the start of the inpatient encounter is more than one hour.