Highland Emergency Observation Unit: Efficient and Effective Care of Short Stay Patients
Highland’s Emergency Observation Unit has been active since 2010 with Robert S. Bennett, M.D., as founder and medical director. The Unit consistently meets its mission of caring for patients who need a short stay for a focused medical or surgical condition and meets or exceeds its target of discharging over 85 percent of its patients within 24 hours. Dr. Bennett cares for patients on the unit, along with Ray Chan, M.D., who has recently joined the coverage team. Both physicians have served Highland for more than 25 years. The following is an interview with Dr. Bennett about why the unit was established and how it contributes to Highland’s reputation for excellence in care.
Why was the Emergency Observation Unit created?
We opened the unit about eight years ago with nine beds to manage observation status patients that were scattered throughout the hospital and generally not differentiated from more acutely ill and complicated patients. As a result, their stays tended to be longer than necessary. By carving out a portion of these patients and placing them in a dedicated unit adjacent to the ED with dedicated staff (physicians, APPs and nurses), these patients could be managed more efficiently. We initially focused on a few problems like chest pain, syncope, and dehydration, but have steadily expanded to include many more conditions which can be managed in a short stay unit.
What does the Emergency Observation Unit look like today?
Today we have 13 beds, four of which are shared, flexibly, with the main ED. Those four beds are dedicated to the EOU overnight but are returned to ED by 11 a.m. the next day. The EOU generally cares for about one third of Highland’s observation patients. Other observation patients are triaged either to the OU (Medical Observation Unit) or scattered on other units.
How has the patient mix changed over the years?
We have seen a shift in our patient mix for the top four most common diagnoses over the past three years. In 2015, about 40 percent of our patients presented with cardiac related symptoms (mostly atypical chest pain), followed by about 15 percent with gastrointestinal symptoms, eight percent with kidney stones, and eight percent with cellulitis. Today about 36 percent present with kidney stones, 35 percent with gastrointestinal symptoms, 11 percent with cellulitis, and nine percent with cardiac symptoms. (See charts)
Why has the patient mix changed?
The significant decrease in chest pain patients is likely directly attributable to the highly sensitive troponin testing introduced earlier this year. These patients are now mostly managed within a few hours in the main ED and discharged home. We have also developed an interest in managing patients with skin and soft tissue infections, who can often be cared for more efficiently in our unit.
What is the biggest impact of the EOU?
Patients seem to love it and give it high Press-Ganey scores. They appreciate how we value their time and can be cared for and discharged if they don’t need to have a more prolonged stay. Studies clearly show that for every hour a patient remains in the hospital, the risk of an adverse event increases. By reducing length of stay, we are maximizing space in the hospital, which is especially important during full census times. In addition to improving the patient experience, the unit is also cost effective for the hospital. This is a win for patients and families and a win for the hospital.