Improving Length of Stay: Transitioning Care from the Emergency Department to a Clinical Decision Unit

Abstract

Session A presented Thursday, September 27, 10:00-11:00 am Purpose: Emergency Departments (ED) experience overcrowding which can lead to unsafe and poor quality outcomes. Overcrowding in the ED can lead to decreased patient satisfaction, rushed and unpleasant treatment environments, distress for those who wait, and poor patient outcomes (Fogarty, Saunders & Cummins, 2013). For these reasons, it is imperative to improve ED throughput times. In addition, decreasing length of stay in an observation unit leads to reduced hospital acquired infections, decreased healthcare costs, increased patient satisfaction, and efficient use of inpatient hospital beds (Asudani & Tolia, 2013). Design: Based on the throughput data analyzed by department leaders, a quality improvement project was undertaken. Setting: At a not for profit community hospital, a transitional care process was implemented to improve ED throughput times as well as to decrease observation length of stay. Participants/Subjects: In collaboration, the emergency department (ED) and clinical decision unit (CDU) staff worked on a care delivery model in which patients who are identified as candidates for the CDU are expedited through the ED, quickly placed in observation status and then transferred to the CDU. Methods: Pre and post data were collected using the electronic documentation system. Results/Outcomes: This change in process resulted in an improvement of throughput from the time the bed is requested to the time the bed is occupied from an average of 2 hours and 4 minutes in October 2016 to an average of 1 hour and 32 minutes in October 2017. In addition, those patients that went to the CDU had consistently shorter observation lengths of stay, than patients that were transferred elsewhere in the hospital under observation status. Implications: The Clinical Decision Unit has shown to be highly effective in decreasing the length of stay of observation patients. Through the collaboration between the ED and CDU teams we increased efficiency and decreased bed request to bed occupied times which subsequently decreases the length of stay of the patient in the ED. The transitional care process expedites the care of the patient being placed in observation status and accelerates the hand off report between nurses which in turn facilitates the patient transfer. In order to meet or exceed publicly reported national throughput benchmarks, leaders should consider instituting a transitional care process and having a short stay unit.