Observation Unit Case Study

Presented by: Lauren Baker, Ben Krueger, Peter Carr, Erin Cheng Skye Weaver & Jessica White

Agenda

Areas of Focus

Current State of UAB

Industry Best Practices

Application to UAB

Recommendations

A best practice guide for the development of a dedicated observation unit at UAB Hospital

Introduction

Introduction

Criteria of Observation Patients

Requires a minimum 4-6

hours of monitoring

Higher probability of

being discharged within 18

hours

Normal EKG and Lab Work

Chief complaint of chest pain or

related symptom

Inpatient admission is not clearly

needed

Patient Satisfaction

Quality of Care

Financial Outcomes

Patient Throughput

Main Issues

Current State of UAB

High Avg. Daily Census

Pending Throughput

Initiative

ED Very Busy

Current State of UAB

ED a Costly Care Delivery Setting

LOS for Potential Observation Patients >30

Hours

Mean Charge $12,900 Mean Collection $1,400

Industry Best Practices:

Emory’s Clinical Decision Unit

CDU Locations

Emory University Hospital

Emory Midtown Hospital

Grady Memorial Hospital

Attending ED

Physician

Associate Providers

Dedicated Nursing

Staff

Case Manager

Staffing Considerations

Operational Considerations

CDU Entrance

CDU Entrance

ED Entrance

ED Entrance

Annual CDU Visits – FY 2011

•1,639

Emory University Hospital

•2,616

Emory Midtown Hospital •1,775

Grady Memorial Hospital

Average Length of Stay

•16.6 Hours2009

•16 Hours2011

CDU Discharge Rates

•83%2009

•85%2011

Improving Quality at Emory

• Decreased rate of missed MI’s• Increase in hospital capacity

(fewer admissions)• Decrease in patients “left-

without-being-seen”• Decrease in ED diversion hours

Outcomes

Application to UAB

Cost

Savings

Financial

Application

Pilot: Innovation Board

ED Observation Unit

Full Implementation with ED Expansion

Recommendations

Requirements• Staffing• Hours• Space

Observation Unit Case Study