Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia.
Department of Emergency Medicine, Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia.
Am J Emerg Med. 2021 Oct;48:231-237. doi: 10.1016/j.ajem.2021.04.079. Epub 2021 Apr 30.
Protocol driven ED observation units (EDOU) have been shown to improve outcomes for patients and payers, however their impact on an entire health system is unknown. Two thirds of US hospitals do not have such units.
To determine the impact of a protocol-driven EDOU on health system length of stay, cost, and resource utilization.
A retrospective, observational, cross-sectional study of observation patients managed over 25 consecutive months in a four-hospital academic health system. Patients were identified using the "admit to observation" order and limited to adult, emergent / urgent, non-obstetric patients. Data was retrieved from a cost accounting database. The primary study exposure was the setting for observation care which was broken into three discrete groups: EDOUs (n = 3), hospital medicine observation units (HMSOU, n = 2), and a non-observation unit (NOU) bed located anywhere in the hospital. Outcomes included observation-to-inpatient admission rate, length of stay (LoS), total direct cost, and inpatient bed days saved. Unadjusted outcomes were compared, and outcomes were adjusted using multiple study variables. LoS and cost were compared using quantile regressions. Inpatient admit rate was compared using logistic regressions.
The sample consisted of 48,145 patients who were 57.4% female, 48% Black, 46% White, median age of 58, with some variation in most common diagnoses and payer groups. The median unadjusted outcomes favored EDOU over NOU settings for admission rate (13.1% vs 37.1%), LoS [17.9 vs 35.6 h), and cost ($1279 vs $2022). The adjusted outcomes favored EDOU over NOU settings for admission rates [12.3% (95% CI 9.7-15.3) vs 26.4% (CI 21.3-32.3)], LoS differences [11.1 h (CI 10.6-11.5 h)] and cost differences [$127.5 (CI $105.4 - $149.5)]. Adjusted differences were similar and favored EDOU over HMSOU settings. For the health system, the total adjusted annualized savings of the EDOUs was 10,399 bed days and $1,329,443 in total direct cost per year.
Within an academic medical center, EDOUs were associated with improved resource utilization and reduced cost. This represents a significant opportunity for hospitals to improve efficiency and contain costs.
已证明，基于协议的急诊观察单位 (EDOU) 可改善患者和支付方的预后，但它们对整个医疗体系的影响尚不清楚。三分之二的美国医院没有此类单位。
确定基于协议的 EDOU 对医疗体系住院时间、成本和资源利用的影响。
对在一个四所医院的学术医疗体系中连续 25 个月管理的观察患者进行回顾性、观察性、横断面研究。使用“收入观察病房”医嘱来识别患者，并将患者限定为成年、紧急/紧急、非产科患者。数据从成本核算数据库中检索。主要研究暴露是观察护理的设置，分为三组：EDOU（n = 3）、医院内科观察病房（HMSOU，n = 2）和医院内任何地方的非观察病房（NOU）床位。结果包括观察转住院的入院率、住院时间 (LoS)、总直接成本和节省的住院床位日。比较未调整的结果，并使用多项研究变量进行调整。使用分位数回归比较 LOS 和成本。使用逻辑回归比较住院入院率。
样本包括 48145 名患者，其中 57.4%为女性，48%为黑人，46%为白人，中位年龄为 58 岁，大多数常见诊断和支付方群体存在一定差异。未经调整的结果显示，EDOU 与 NOU 相比，入院率（13.1% vs 37.1%）、LoS [17.9 与 35.6 h]和成本（$1279 与 $2022）更优。调整后的结果显示，EDOU 与 NOU 相比，入院率[12.3%（95%CI 9.7-15.3）比 26.4%（CI 21.3-32.3）]、LoS 差异[11.1 h（CI 10.6-11.5 h）]和成本差异[$127.5（CI 105.4 - $149.5）]更优。调整后的差异相似，且 EDOU 优于 HMSOU。对于整个医疗体系，EDOU 的年调整总节省床位日为 10399 天，总直接成本节省 1329443 美元。
在学术医疗中心内，EDOU 与改善资源利用和降低成本相关。这为医院提高效率和控制成本提供了重要机会。
