Impact of emergency short‐stay unit opening on in‐hospital global and cardiology indicators

Abstract

Rationale, aims and objectives: Emergency short-stay unit (SSU) alleviates emergency department (ED) overcrowding, but may affect in-hospital indicators. Cardiology patients comprise a substantial part of patients admitted at SSU. This study evaluated whether SSU opening differentially modified in-hospital indicators at a whole general hospital and at its cardiology division (CARD). Methods: We retrospectively analysed indicators based on 859 686 ED visits, and 171 547 hospital admissions, including 12 110 CARD admissions, from 2007 to 2018 at a general tertiary hospital, and compared global ED indicators and in-hospital indicators at the hospital and CARD before (2007-2011) and after (2011-2018) SSU opening. Results: After SSU opening, monthly ED bed occupancy rate decreased (mean ± SD 200 ± 18% vs 187 ± 22%; P < .001) and in-hospital admissions from ED increased at the hospital (median [interquartile range] 460 [81] vs 524 [41], P < .001) and CARD (50 [12] vs 54 [12], P = .004). In parallel, monthly in-hospital elective admissions decreased at CARD (34 [18] vs 28 [17], P = .019), but not at the hospital (712 [73] vs 700 [104], P = .54). Average length of stay (LOS) increased at both hospital (8.5 ± 0.3 vs 8.7 ± 0.4 days, P < .001) and CARD (9.2 ± 1.5 vs 10.3 ± 2.3 days, P = .002) after SSU opening, but percent admissions at SSU showed a direct relationship with LOS solely at CARD. Furthermore, cardiology patients admitted at SSU had greater LOS, prevalence of coronary heart disease and age than those admitted at the conventional cardiology ward.Conclusions: SSU opening improved ED crowding, but was associated with changes in in-hospital indicators, particularly at CARD, and in the characteristics of hospitalized cardiology patients. These findings suggest that in-hospital cardiology services may need re-evaluation following SSU opening at a general hospital.

Emergency short stay area improves access and flow in a rural hospital

“…Emergency short stay areas (ESSAs, also called emergency short stay units) have been successfully used as a model of care (MOC) in both Australian and international settings for management of various conditions 13,15–20 . ESSAs provide an area where patients can be admitted with conditions that are expected to respond rapidly to treatment.…”

“…They represent an area where patients with expected stays of less than 24 h can be admitted, receive treatment and ongoing assessment, and have discharge plans and supports formulated. With severe access block they may be used to house inpatients, but this is not their primary purpose, and placing inpatient admissions in the ESSA is not supported by the ESSA MOC 15,17,18,20 …”

“…14,15 Emergency short stay areas (ESSAs, also called emergency short stay units) have been successfully used as a model of care (MOC) in both Australian and international settings for management of various conditions. 13,[15][16][17][18][19][20] ESSAs provide an area where patients can be admitted with conditions that are expected to respond rapidly to treatment. They leverage the 24 h ED staffing to allow discharge when the patient has improved, rather than when an admitting team next do a ward round.…”

“…With severe access block they may be used to house inpatients, but this is not their primary purpose, and placing inpatient admissions in the ESSA is not supported by the ESSA MOC. 15,17,18,20 ESSAs can assist in reducing length of stay (LOS)usually via providing an admission option for patients who are not dischargeable within 4 h, but do not require formal inpatient care. By keeping the patient's care within the ED but out of the acute assessment areas, the inefficiencies of ward-based care are avoided, reducing ED overcrowding and improving patient safety and satisfaction.…”