Your AKI measure numerator is ludicrous. If a patient presents with septic shock, receives perfect care and yet over the next 48 hours has progressive loss of renal function and develops AKI, that would be considered preventable/reportable? If they present with a SCr of 2 from hepatorenal syndrome and develop worsening AKI, that is preventable/reportable? There are a great number of patients whose renal function is deteriorating on arrival to the hospital yet their SCr is below 4. If their SCr reaches a point over 1.5 baseline, that is considered preventable/reportable? It should also be noted that a large number of patients have no baseline SCr available; are they excluded from this measure? This needs to go back to the drawing board and start over.
Finally, "Observational status" is just plain old gibberish. Observation is not a status; it is a service provided to outpatients. Some do use the term "observation status" but certainly not "observational status."