Making Greater Use Of Dedicated Hospital Observation Units For Many Short-Stay Patients Could Save $3.1 Billion A Year

Abstract

Using observation units in hospitals to provide care to certain patients can be more efficient than admitting them to the hospital and can result in shorter lengths-of-stay and lower costs. However, such units are present in only about one-third of US hospitals. We estimated national cost savings that would result from increasing the prevalence and use of observation units for patients whose stay there would be shorter than twenty-four hours. Using a systematic literature review, national survey data, and a simulation model, we estimated that if hospitals without observation units had them in place, the average cost savings per patient would be $1,572, annual hospital savings would be $4.6 million, and national cost savings would be $3.1 billion. Future policies intended to increase the cost-efficiency of hospital care should include support for observation unit care as an alternative to short-stay inpatient admission.

National Cost Savings From Observation Unit Management of Syncope

“…The Monte Carlo approach has also been used previously in medical research, including a recent analysis of overall cost savings generated from increased observation unit use. 12,[16][17][18] Monte Carlo simulation calculates and records the results of many simulated iterations using random values of the input variables in each iteration. These values are chosen from data distributions that are directly informed by prior studies.…”

“…For hospitals with between 20,000 and 50,000 ED visits, we assumed that only half of the admission volume from these institutions would occur with an available dedicated observation unit, consistent with a similar prior analysis. 12 For all hospitals with more than 50,000 visits, we assumed that there is sufficient patient volume to operate a dedicated observation unit. We assumed a need for subsequent inpatient care in a portion of observation visits, using the value discovered in the EDOSP study and assuming that no cost savings result from these.…”

“…In this analysis, we similarly refer to cost from the hospital perspective, which is consistent with previous cost analyses in the area of observation medicine. 12 Study Setting and Population High-risk patients, including those with identified dangerous conditions such as symptomatic arrhythmia, typically require hospitalization. Low-risk patients who have presumptive and non-life-threatening causes of syncope, such as a vasovagal mechanism, can be discharged directly home.…”

“…All prior studies showing cost savings from observation use were performed in dedicated settings using protocols of care. 12 The use of observation care continues to rise and research supporting the benefit attributed to the setting of this care is more relevant today than ever before. 13 To our knowledge, the only multicenter study to examine the cost difference between patients with syncope or presyncope randomized to protocolized care in a dedicated observation unit versus routine care in an inpatient setting is the Emergency Department Observation Syncope Protocol (EDOSP).…”

Utilization of Observation Units for the Care of Poisoned Patients: Trends from the Toxicology Investigators Consortium Case Registry

“…In many ways, poisoned patients are suitable candidates for observation management: (1) the toxicodynamic properties of most toxicants are fairly predictable [11], (2) patients with unknown ingestions or who have ingested a substance with sustained-release properties can be monitored for delayed toxicity [16], (3) the vast majority of these patients are likely to be discharged within 24 h [11,13,14,17], (4) only a small percentage of poisoned patients fail observation and require inpatient admission [11][12][13][14]17], and (5) these patients can receive support to address emotional and psychiatric issues [16]. While the number of dedicated observation units in hospitals is growing across the USA [18,19], very few studies have exclusively evaluated the utilization or experience of observation units for poisoned patients [11][12][13][14]. Findings from these studies, while useful, are limited for several reasons.…”