4. Introduction
Criteria of Observation Patients
Higher
Chief
Requires a probability of Inpatient
complaint of
minimum 4-6 being Normal EKG admission is
chest pain or
hours of discharged and Lab Work not clearly
related
monitoring within 18 needed
symptom
hours
5. Main Issues
Patient Quality of Financial Patient
Satisfaction Care Outcomes Throughput
6. Current State of UAB
High Avg.
Daily Census
Pending
ED Very
Throughput
Busy
Initiative
7. Current State of UAB
LOS for Potential
ED a Costly Care
Observation Patients >30
Delivery Setting
Hours
Mean Charge $12,900 Mean Collection $1,400
Patient SatisfactionDecrease Wait TimesQuality of visitSpecialized treatmentLower nurse to patient ratioQuality of CareDecrease ReadmissionIncrease specialty of cliniciansFinancial OutcomesDecreasing Length of Stay (LOS)Appropriate level of careMore accurate billingRevenue maximizationPatient ThroughputCooper Green ClosingLarge volume of cardiac patientsDiversionStreamline process in emergency room and observation unit
Emory University c.2006Emory Midtown c.2003Grady Memorial Emory selected for case study based on leadership in observation medicine and operational similarities. The framework that Emory has established for their CDUs serves as a benchmark for other large health systems (such as UPMC). Emory has hosted 2 “State-of-the-Art” lectures on observation medicine and even offers a Fellowship in Observation Medicine. UAB is similar to Emory in several aspects of emergency medicine, especially in regards to case mix and capacity restrictions.
Attending Physicians round at the beginning of every shift. “Gatekeepers” for admission into the CDU. Associate Providers (2) compliment the attending ED physician’s patient management. In the CDU the AP, along with an attending physician, oversee the daily management of the CDU including rounding on patients, cardiac risk stratification, and collaborating with specialty services to coordinate patient care.All patients are evaluated by a case manager who helps coordinate care, provide education, and ensure appropriate follow-up. The unit admits patients directly from the Emergency Department.
Industry average – 82.3% of observation units located within or adjacent to the EDEmory University Hospital – 8 BedsEmory Midtown Hospital – 8 BedsGrady Memorial Hospital – 7 Beds but will be expanding to 20 Beds by the end of 2013.
Total Visits – 6,030 or roughly 16.5 patients/day.
Average LOS based on: CDU hoursTotal CDU+ED hoursCDU Admit hoursCDU Discharge hours CDU Admit LOS is roughly 2 hours longer than CDU Discharge LOS
