Related Experiment Videos
Implementing emergency department observation units within a multihospital network
1Department of Traumatology and Emergency Medicine, University of Connecticut School of Medicine, Farmington, USA. louisgraff@home.com
The Joint Commission Journal on Quality Improvement
|July 18, 2000
Summary
Emergency department observation units improve care for chest pain patients by increasing evaluations for myocardial infarction (MI). These units are cost-effective, reducing patient charges compared to traditional hospital stays.
Area of Science:
- Emergency Medicine
- Health Services Research
- Cardiology
Background:
- Extended evaluation for chest pain in the emergency department (ED) impacts healthcare quality and cost.
- Higher rates of extended evaluations correlate with lower missed myocardial infarction (MI) rates.
- Implementing ED observation units was explored as a strategy to improve MI rule-out processes.
Purpose of the Study:
- To evaluate the impact of ED observation units on the diagnostic process for acute chest pain patients.
- To assess the cost-effectiveness of ED observation units compared to traditional hospital admission for chest pain evaluations.
- To determine if ED observation units improve the rate of extended rule-out myocardial infarction (MI) evaluations.
Main Methods:
- A comparative study involving five hospitals that implemented ED observation units within a multihospital network.
- Analysis of patient observation and rule-out MI evaluation rates before and after unit implementation, using historical and case controls.
- Collection and comparison of patient service charges for those evaluated in ED observation units versus inpatient hospital settings.
Main Results:
- Hospitals with ED observation units demonstrated significantly higher observation (16% vs. 0-2%) and rule-out MI evaluation rates (61% vs. 45-46%).
- Admission rates did not significantly increase in hospitals with observation units (47% vs. 45-46%).
- Cost analysis revealed lower patient service charges in ED observation units ($2,214.80) compared to inpatient hospital stays ($5,464.30) for patients with negative rule-out MI evaluations.
Conclusions:
- ED observation units offer a cost-effective restructuring of acute chest pain diagnostic pathways.
- These units improve patient care quality by enabling a greater proportion of ED chest pain patients to receive extended evaluations.
- Observation units provide a valuable alternative to hospital admission as the sole disposition option for ED chest pain patients.