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Preliminary results from the latest national survey of observation units show that urban hospitals are more likely than rural hospitals to have them.
Sharon Mace, MD, clinical director of the observation unit in the Department of Emergency Medicine at the Cleveland Clinic Foundation headed the study. The survey was commissioned by the American College of Emergency Physicians in Irving, TX.
Other preliminary findings based on a national sample of hospitals show:
• Between 22% and 25% of all hospitals have observation units.
• About 19% of rural hospitals have units.
• About 25% of urban hospitals have units.
• Academic medical centers are more likely to have observation units than community hospitals.
• Most units (60%) are located in emergency departments (EDs). Other hospitals place them on various patient care units. Some (usually academic centers) put them in both locations.
Reimbursement is a challenge to financial solvency for observation units in EDs and other hospital service areas. David Magid, MD, MPH, director of the emergency department observation unit at Exempla St. Joseph Hospital in Denver, explains that some health care organizations do not receive adequate third-party payments for the level and intensity of service. "That probably keeps more hospitals from installing the units," he notes.
Exempla St. Joseph faces fewer vagaries in reimbursement because the majority of its observation patients are members of the Kaiser Permanente HMO. However, Magid points out, "The hospital’s decision was based on the belief that it would be good for all its patients." In fact, the 11-bed unit operates on a full census, drawn from the 50,000 ED visits per year. The unit shows stellar results in patient outcomes, satisfaction, and the bottom line.
Magid credits the unit’s success primarily to:
• Clinicians with skills and affinity for observation. For nurses, that includes skills in emergency care and the use of cardiac monitors. Mace notes that observation nurses often have backgrounds in medical-surgical or coronary care with training in telemetry. She adds that those who really enjoy emergency care are likely to find the observation unit too slow.
• Continuous collection and monitoring of data. Exempla St. Joseph continually watches admission and discharge trends to ensure appropriate placement of patients in observation or inpatient care. For example, while chronic obstructive pulmonary disease patients were formerly served in the observation unit, they are now admitted to the hospital. "They get sick over several days at home, and it takes them several days to get better. So it’s best to admit them to the inpatient unit where they can get care during the course of their recovery," says Magid.
For more on operating an observation unit, contact:
- David Magid, MD, Kaiser Permanente, Denver. E-mail: firstname.lastname@example.org.
- Louis Graff, MD, Associate Director of the Emergency Department, New Britain General Hospital, 100 Grand St., New Britain, CT 06050. Telephone: (860) 224-5675. E-mail: email@example.com.
For background data regarding observation units, contact:
- American College of Emergency Physicians, 1125 Executive Circle, Irving, TX 75038-2522. Telephone: (800) 798-1822. Web site: www.acep.org.