Often, the emergency department (ED) or emergency medicine (EM) services oversee observation units as the goal is to improve ED throughput and the inpatient admission process.
However, a Short Stay Unit (SSU) unit managed by a hospital medicine (HM) program can result in significant improvements when implemented with APP-driven protocols.
The Advantage of Hospital Medicine Managed Units
In 2023, Core partnered with a community hospital in the South that was struggling to meet its length of stay (LOS) goals. Among other interventions, a new 14-bed Short Stay Unit proved to optimize throughput and we saw a sustained improvement in its inpatient LOS. The SSU was operated by Advanced Practice Providers (APP) with physician oversight. Core partnered with the hospital to develop APP driven protocols that facilitate timely care. All patients admitted to observation status were assessed for SSU appropriateness and admitted to the SSU by the APC.
Results
The Observation Length of Stay (LOS) was 0.75 days shorter for observation patients in the short-stay unit (SSU) than for observation patients in inpatient units. Since initiating the SSU model, the percentage of patients placed in observation and discharged within 24 hours has increased from 24% to 35%. Inversely, the rate of patients placed in observation with an LOS of over 72 hours has decreased from 15% to 6% since implementation.
Comprehensive Approach and Continuous Improvement
When used in conjunction with interdisciplinary rounding, improved communication, and focused recruiting and retention efforts, an inpatient observation unit managed by the HM program can prove to be an important part of the solution for reducing inpatient LOS. A crucial piece of this success is continuous auditing and improvement of the program. Shortly after implementing the program at one hospital, other locations within the system began adopting this model for their own facilities.