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Related Experiment Videos

Implementing emergency department observation units within a multihospital network.

L Graff1, M Prete, M Werdmann

  • 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
PubMed
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.

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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.

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  • 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.