J Emerg Nurs. 2023 Nov;49(6):853-862. doi: 10.1016/j.jen.2023.07.002. Epub 2023 Aug 31.
This project aimed to design and implement an emergency department-managed observation unit that improves inpatient bed and emergency department stretcher capacity, decreases observation patient length of stay, earns high patient satisfaction scores, and generates a positive fiscal impact on the organization.
This quality improvement project followed a 1-group, pre- and postprogram implementation design.
In the first year of operations, 40% of the total observation patients treated in this hospital were managed in the new observation unit. Emergency department observation unit length of stay across all patient complaints was half of the average length of stay for observation patients located on hospital inpatient units. In most cases, the emergency department observation unit was in the top 25 percentile of hospital Press Ganey inpatient satisfaction categories. The hospital estimates a contribution margin of three-quarters of a million dollars in the first year.
This effective and efficient hybrid observation unit possessed specific aspects of inpatient and emergency department patient care models. Placing providers and nurses at the workstation for faster communication expedited care. Prioritizing all observation patient testing, transportation, phlebotomy, and intravenous (IV) services shortened disposition times. Emergency nurses transitioning to the observation unit were challenged to acquire inpatient care knowledge. Observation unit management struggled to maintain staffing while under an inpatient productivity model managed by the inpatient house supervisor. Reducing patient disposition time required clear communication between observation unit and inpatient staffing managers, between physician consultants and advanced practice nursing providers, and among nurses, patients, and providers. Observation units are 1 solution to decrease observation patient length of stay and improve emergency department capacity.
本项目旨在设计和实施一个由急诊部管理的观察单元，以提高住院床位和急诊部担架的容量，缩短观察患者的住院时间，获得高患者满意度评分，并对组织产生积极的财务影响。
本质量改进项目采用了 1 组预前后实施设计。
在运营的第一年，该医院 40%的观察患者在新的观察单元中得到了治疗。在所有患者投诉中，急诊观察单元的停留时间是医院住院患者观察单元平均停留时间的一半。在大多数情况下，急诊观察单元在医院盖尔尼住院满意度类别中位列前 25%。医院估计第一年的边际贡献为 75 万美元。
这个高效的混合观察单元具有住院和急诊患者护理模式的特定方面。将提供者和护士安置在工作站上，以便更快地进行沟通，加快了护理速度。优先考虑所有观察患者的测试、运输、采血和静脉（IV）服务，缩短了处置时间。急诊护士向观察单元的过渡面临着获取住院护理知识的挑战。观察单元管理在面临由住院主管监督管理的住院生产力模型时，难以维持人员配置。缩短患者处置时间需要观察单元和住院人员配置经理、医师顾问和高级实践护理提供者之间、护士、患者和提供者之间进行清晰的沟通。观察单元是缩短观察患者住院时间和提高急诊部容量的解决方案之一。
