Emergency department observation beds improve patient care: Society for academic emergency medicine debate

Graff, Louis; Zun, Leslie S.; Leikin, Jerrold B.; Gibler, Brian; Weinstock, Michael S.; Mathews, James; Benjamin, Georges C.

doi:10.1016/s0196-0644(05)82937-3

Cited by 22 publications

(5 citation statements)

References 38 publications

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“…16 Participants identified the potential for the CDU to lead to prolonged EP decision making, extended waiting for patients requiring specialist consultation, or delays in hospital admission, as noted elsewhere. 11,[17][18][19] Clearly articulated policies for the unit and well-defined admission criteria were considered important in ensuring appropriate use of the CDU. The issue of clinical governance and the importance of ED ownership of the unit, first acknowledged by Krome,20 remains an important caveat for prospective sites.…”

Section: Themes and Implicationsmentioning

confidence: 99%

Barriers and facilitators to the implementation of Ontario's emergency department clinical decision unit pilot program: a qualitative study

Salkeld

Leaver

Guttmann

et al. 2011

CJEM

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Objective: In Ontario, clinical decision units (CDUs) were implemented as a pilot project in 2008 by the Ministry of Health and Long-Term Care as part of its strategy to reduce emergency department (ED) waiting times. Our objective was to describe general characteristics of the program at each of the participating sites and to examine barriers and facilitators to integrating CDUs into practice. Methods: On-site small-group interviews were conducted in two phases with ED and hospital staff at participating sites, first at 8 to 12 weeks and again at 12 months postimplementation. Interview data were analyzed using the framework approach. Unstructured field notes and CDU clinical care protocols and documentation were also reviewed. Results: The qualitative analysis identified 10 key themes related to integrating CDUs into EDs: shift in clinical and operational practice; administrative aspects of implementation; team building and stakeholder involvement; use of clinical care protocols; physical or virtual model of care; responsive ancillary services; involvement of specialist services; coordination with hospital and community supports; appropriate use of the CDU; and ongoing evaluation and monitoring. Each theme represents an important insight from the perspective of clinical and administrative staff at participating sites. Conclusion: The implementation of CDUs is a complex process, with no single preferred clinical care or operational model. This study identifies a number of key considerations relevant to the future implementation of CDUs. RÉ SUMÉObjectif : Le ministè re de la Santé et des Soins de longue duré e de l'Ontario a instauré en 2008 des unité s de dé cision clinique (UDC) à titre de projet pilote dans le cadre de sa straté gie visant à ré duire les temps d'attente dans les services d'urgence (SU). Notre objectif consistait à dé crire les caracté ristiques gé né rales du programme dans chacun des sites participants et à examiner les obstacles et facteurs favorables à l'inté gration des UDC à la pratique. Mé thodes : Des entretiens sur place auprè s de petits groupes ont é té mené s en deux é tapes avec le personnel de l'hô pital et du SU des sites participants, d'abord aprè s 8 à 12 semaines, puis 12 mois aprè s la mise en oeuvre des UDC. Les donné es recueillies lors des entretiens ont é té analysé es suivant la dé marche-cadre. Nous avons aussi examiné les notes d'inspection non structuré es, ainsi que la documentation et les protocoles de soins cliniques des UDC. Ré sultats : L'analyse qualitative a dé gagé 10 thè mes clé s lié s à l'inté gration des UDC aux SU : virage dans la pratique clinique et opé rationnelle; aspects administratifs de l'instauration; cré ation d'un esprit d'é quipe et mise à contribution des parties inté ressé es; utilisation de protocoles de soins cliniques; modè le de soins physique ou virtuel; services auxiliaires ré actifs; mise à contribution des services des spé cialistes; coordination avec le soutien de l'hô pital et de la collectivité ; utilisation approprié e des...

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Section: Themes and Implicationsmentioning

confidence: 99%

Barriers and facilitators to the implementation of Ontario's emergency department clinical decision unit pilot program: a qualitative study

Salkeld

Leaver

Guttmann

et al. 2011

CJEM

View full text Add to dashboard Cite

show abstract

“…In this study, serious complications occurred in 28% of the patients who were triaged to stepdown units compared with 39% of coronary care unit patients. Even after adjusting for clinical differences between the populations in these two levels of care, there was no Today, however, the intei~nediate care unit is being complemented by a new type of facility that is often within the emergency department itself [6][7][8].…”

Section: A New Management Strategymentioning

confidence: 99%

“…In one recent study [4], for example, researchers at Brigham and Women's Hospital performed a timeseries trial involving 1921 emergency department patients with acute chest pain [7]. During intervention periods, the physicians who evaluated and cared for these patients in the emergency department and after admission were provided with estimates of the patients' risks for major complications and triage recommendations that varied according to those risk estimates.…”

Section: Guidelines and Pathwaysmentioning

confidence: 99%

Emergency department observation units: Has the time come?

Lee

1996

J Thromb Thrombol

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Background: Economic pressures for efficiency in health care have led to the need for new strategies for the care of patients with acute chest pain. Methods: Chest pain observation units have been developed in many hospitals and are widely considered to have the potential to provide rapid and safe evaluations for low-risk patients with acute chest pain. Critical pathways are also an increasingly used strategy for the management of this patient population. Results: Available data suggest that chest pain observation units can decrease 6 month resource utilization compared with patients admitted to traditional sites of care. However, the potential exists for these units to increase resource utilization by encouraging admissions to the hospital of patients who otherwise would have been discharged directly home. Conclusions: Chest pain observation units appear to be an important innovation for the care of patients with a low risk for acute myocardial infarction. Use of guidelines for the se units may permit true increases in efficiency without compromising quality.

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“…Chest pain centers, the precursor of today’s OU’s, were established in the early 1980’s [20]. Recognizing that if an OU does not have knowledgeable and accountable leadership implementing a functional operation plan, it will add to rather than resolve ED problems, the American College of Emergency Physicians (ACEP) set up and developed the concept of observation medicine in 1988 [9,21-24]. However, more than two decades later, the quandary of setting up an OU that meets benchmark levels of operation remains an ongoing challenge to hospitals that would benefit from this resource worldwide.…”

Section: Introductionmentioning

confidence: 99%

Key operational characteristics in emergency department observation units: a comparative study between sites in the United States and Asia

et al. 2014

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BackgroundTo improve efficiency, emergency departments (EDs) use dedicated observation units (OUs) to manage patients who are unable to be discharged home, yet do not clearly require inpatient hospitalization. However, operational metrics and their ideal targets have not been created for this setting and patient population. Variation in these metrics across different countries has not previously been reported. This study aims to define and compare key operational characteristics between three ED OUs in the United States (US) and three ED OUs in Asia.MethodsThis is a descriptive study of six tertiary-care hospitals, all of which are level 1 trauma centers and have OUs managed by ED staff. We collected data via various methods, including a standardized survey, direct observation, and interviews with unit leadership, and compared these data across continents.ResultsWe define multiple key operational characteristics to compare between sites, including OU length of stay (LOS), OU discharge rate, and bed turnover rate. OU LOS in the US and Asian sites averaged 12.9 hours (95% CI, 8.3 to 17.5) and 20.5 hours (95% CI, -49.4 to 90.4), respectively (P = 0.39). OU discharge rates in the US and Asia averaged 84.3% (95% CI, 81.5 to 87.2) and 88.7% (95% CI, 81.5 to 95.8), respectively (P = 0.11), and the bed turnover rates in the US and Asian sites averaged 1.6 patients/bed/day (95% CI, -0.1 to 3.3) and 0.9 patient/bed/day (95% CI, -0.6 to 2.4), respectively (P = 0.27).ConclusionsPrior research has shown that the OU is a resource that can mitigate many of problems in the ED and hospital, while simultaneously improving patient care and satisfaction. We describe key operational characteristics that are relevant to all OUs, regardless of geography or healthcare system to monitor and maximize efficiency. Although measures of LOS and bed turnover varied widely between US and Asian sites, we did not find a statistically significant difference. Use of these metrics may enable hospitals to establish or revise an ED OU and reduce OU LOS, increase bed turnover, and discharge rates while simultaneously improving patient satisfaction and quality of care.

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Emergency department observation beds improve patient care: Society for academic emergency medicine debate

Cited by 22 publications

References 38 publications

Barriers and facilitators to the implementation of Ontario's emergency department clinical decision unit pilot program: a qualitative study

Barriers and facilitators to the implementation of Ontario's emergency department clinical decision unit pilot program: a qualitative study

Emergency department observation units: Has the time come?

Key operational characteristics in emergency department observation units: a comparative study between sites in the United States and Asia

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