Impact of the 2 South Observation Unit on Care Processes for Chest Pain, Syncope and Abdominal ...

328 Pages·2011·9.02 MB·English

Impact of the 2 South Observation
Unit on Care of Patients Presenting
With Chest Pain, Syncope and
Abdominal Pain
Aziz Ansari, DO, FHM
Elizabeth Schulwolf, MD MA
Helen Lee, MD
Laura Digangi
Jan Lukas, RN
Opportunity Statement
Observation units focus on a subgroup of patients

who are less critically ill than patients who require full
ad mission to the hospital
These units provide centralized care which improves

efficiency

We sought to evaluate effects on length of stay

(LOS) and total charges in selected observation
sta tus patients before and after establishing the
Observation Unit at Loyola
Data timeline:

Pre-project baseline: FY Q4 2009
–

Post implementation: FY Q4 2010
–
Observation Status Definition
Observation status is an outpatient class of service for

a patient requiring the use of a hospital bed, periodic

monitoring and meets medical necessity
We analyzed only those patients that were classified as

observation status on admission in both groups

We excluded patients that were:

Classified as inpatient at any time during the admission in
–

both groups, regardless of the patients’ length of stay
Transitioned to inpatient status during their admission
–
Aim Statement
Reduce total charges and LOS with the

establishment of the 2 South Observation

Unit in patients with the 3 most common
diagnoses encountered:
Chest pain
–
Syncope
–
Abdominal Pain
–
Solutions Implemented
A closed unit was established on 2 South that is

staffed by hospitalists, a core group of nurses

and patient care technicians
To capture patients most appropriate for care on

the observation unit a hospitalist screened the

patients needing additional care in the hospital
The ER physicians were educated on triaging

patients prior to calling the hospitalist to discuss

the cases
Methods
Administrative data from Quarter 4 of 2009 (pre) was

compared to Quarter 4 of 2010 (post)
All patients were cared for by a hospitalist

Patient cohorts were compared overall and then by

pri mary diagnosis: chest pain, syncope or abdominal
pain

Continuous variables (charges and LOS) were

compared using t-test
Dic hotomous variables were compared using chi-

square test
All data was analyzed using Stata 11, College Station,

TX and Microsoft Excel
Results: LOS
s
r
u
o
H
Results: Percentage of Patients Hospitalized
Longer than 24 Hours
P<0.001 P=0.003 P=0.013 NS
Results: Total Charges
s
r
a
l
l
o
D
Analysis of Data
We found that the overall average LOS was significantly

decreased in the OBS unit (19.04 hours vs. 29.55 hours)
Ov erall Charges also significantly decreased ($7,230 vs.

$8,709)
In chest pain patients, significant decreases were seen in LOS

(17.92 hours vs. 26.71 hours) and charges ($7,157 vs. $8,920)
In syncope patients, LOS significantly decreased (23.00 hours

vs. 43.44 hours)
In abdominal pain patients, no statistically significant results

were found
Ov erall, the percentage of patients staying beyond 24 hours

was reduced from 65% baseline to 35% post implementation of
the 2S Observation Unit