Observation units were initially intended to function as a short stay unit for lower acuity patients with specific diagnoses, however this traditional model is currently evolving. Rising health care costs and changing health care policy have resulted in an increase utilization of the observation unit and an expansion of diagnostic criteria to include more complex patients. Additionally, 30-day readmission penalties for specific diagnoses have encouraged providers to think about how to more efficiently manage these patients. Observation unit staffing is one of the key factors that contribute to its success. Given the increase complexity of comorbidities and socioeconomic challenges patients, hospitalists are best suited to meet these patients’ needs.
We reviewed data in our urban academic health system and compared important institutional metrics since the implementation of our units. Our institution is a tertiary, academic institution with a hospitalist-run observation unit.
We implemented a 23-bed telemetry capable observation unit at our urban academic medical center in August 2014. We have a closed, geographic unit located outside of the emergency department staffed by hospitalists and advanced care practitioners. Patient selection is determined by provider judgment and Millman Criteria is used as a reference. Direct provider turnover is given for each patient. We present our unit metrics including length of stay, inpatient conversion rate, avoided readmissions and patient satisfaction. We treat approximately 400 patients per month on average and have over 11,000 visits since opening. Additionally we evaluate the impact of our observation unit on denial rates and 1-day length of stay as we compare within our health system
The future of observation unit care is evident with our evolving health care system. The hospitalist role is becoming more significant as we transform from a fee for service to population health based model. We are managing more medically complex patients with challenging socioeconomic backgrounds. This requires clinical and institutional expertise in order to manage these patients with high quality and efficiency. Additionally, we have demonstrated the substantial role our observation unit has had on the reduction of 1-day length of stay and denial rate, ultimately leading to a notable financial impact to our health system. We have also noted the positive influence on patient satisfaction, which is likely affected by intensive, efficient patient throughput.