Implementing Emergency Department Observation Units Within a Multihospital Network

Emergency department visits: the cost of trauma centers

“…Critical Decision Units (CDUs), also known as observation units, separate care for observation of patients for up to 23 hours to determine whether admission is necessary, often avoiding inpatient stays of two to three times that length. There is evidence that CDUs reduce inpatient costs [13,21,26], and CDU expansion was a major recommendation of the IOM Report. As an alternative to adding more beds to the higher acuity existing units, it might be more feasible for some hospitals to keep the current ED bed base and add an observation unit.…”

Measuring and Improving Quality in Emergency Medicine

“…The proportion of patients with an extended evaluation (rule out MI evaluation) increases with ED observation units, which correlates with decreasing the missed MI rate. Graff et al 32 implemented ED chest pain units at five of ten hospitals. These hospitals, compared with historical and case controls, had a higher observation rate (16% vs 0%, 16% vs 2%) and a higher ''rule out MI evaluation'' rate (61% vs 46%, 61% vs 45%), without a significantly higher admission rate (47% vs 46%, 47% vs 45%).…”

Improving healthcare delivery with lean thinking

“…It is also likely that an observation unit only complicates the existing organisation. Many hospitals have experienced in practice that their observation units created more problems when they were not properly managed (Brillman et al, 1995;Graff et al, 2000;Daly et al, 2003;Scott et al, 2009). Especially in academic settings, conflicts over patients are likely to occur because there are so many specialties and sub-specialties.…”

“…It was also considered that the investment involved in the implementation is typically large and that the operating costs are higher than those of a regular nursing ward (Zun, 1990); the nursing staff needs additional training to know about patients' symptoms from many specialities (Scott et al, 2009). In addition, the observation unit requires its own decision-making and management, with the associated problems in stakeholder responsibilities (Graff et al, 2000;Daly et al, 2003;Scott et al, 2009). Hospital management, instead, used the key insights from the analyses to optimise the outflow of ED patients into the wards.…”

“…An observation unit provides a buffer to accommodate overflowing in the ED. It also removes disturbances for the nursing wards and prevents unnecessary admissions (Graff et al, 2000). The literature shows that observation units generally improve patient care, but that there are serious drawbacks as well (Zun, 1990;Brillman et al, 1995;Gouin et al, 1997;Rydman et al, 1999;Daly et al, 2003;Mace et al, 2003;Scott et al, 2009).…”