The impact of emergency department observation units on a health system
| Autor: | Nicole Franks, Anwar Osborne, Tim P. Moran, Dane Peterson, Michael A. Ross, Stephen R. Pitts, Michael J. Perry |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty Logistic regression 03 medical and health sciences 0302 clinical medicine Clinical Observation Units Humans Medicine Aged Retrospective Studies Academic Medical Centers Multi-Institutional Systems business.industry Health services research 030208 emergency & critical care medicine Admission rate Health Care Costs General Medicine Emergency department Length of Stay Middle Aged Direct cost Hospital medicine Hospitalization Logistic Models Emergency medicine Emergency Medicine Health Resources Female Observational study Emergency Service Hospital business Reduced cost |
| Zdroj: | The American Journal of Emergency Medicine. 48:231-237 |
| ISSN: | 0735-6757 |
| DOI: | 10.1016/j.ajem.2021.04.079 |
| Popis: | Importance 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. Objective To determine the impact of a protocol-driven EDOU on health system length of stay, cost, and resource utilization. Methods 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. Results 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. Conclusion 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. |
| Databáze: | OpenAIRE |
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