دورية أكاديمية
أعرض في EDS

The impact of emergency department observation units on a health system.

التفاصيل البيبلوغرافية
العنوان: The impact of emergency department observation units on a health system.
المؤلفون: Perry M; Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia., Franks N; Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia., Pitts SR; Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia., Moran TP; Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia., Osborne A; Department of Emergency Medicine, Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia., Peterson D; Emory Healthcare, Atlanta, Georgia., Ross MA; Department of Emergency Medicine, Observation Medicine, Emory University School of Medicine, 531 Asbury Circle - Annex, Suite N340, Atlanta, Georgia. Electronic address: maross@emory.edu.
المصدر: The American journal of emergency medicine [Am J Emerg Med] 2021 Oct; Vol. 48, pp. 231-237. Date of Electronic Publication: 2021 Apr 30.
نوع المنشور: Journal Article; Observational Study
اللغة: English
بيانات الدورية: Publisher: W B Saunders Country of Publication: United States NLM ID: 8309942 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-8171 (Electronic) Linking ISSN: 07356757 NLM ISO Abbreviation: Am J Emerg Med Subsets: MEDLINE
أسماء مطبوعة: Publication: 1983- : Philadelphia, PA : W B Saunders
Original Publication: [Philadelphia, PA. : Centrum Philadelphia, c1983]-
مواضيع طبية MeSH: Academic Medical Centers* , Multi-Institutional Systems*, Clinical Observation Units/*economics , Emergency Service, Hospital/*economics , Health Care Costs/*statistics & numerical data , Hospitalization/*economics , Length of Stay/*economics, Adult ; Aged ; Clinical Observation Units/statistics & numerical data ; Emergency Service, Hospital/statistics & numerical data ; Female ; Health Resources/economics ; Health Resources/statistics & numerical data ; Hospitalization/statistics & numerical data ; Humans ; Length of Stay/statistics & numerical data ; Logistic Models ; Male ; Middle Aged ; Retrospective Studies
مستخلص: 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.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
فهرسة مساهمة: Keywords: Emergency department; Health services research; Observation unit
تواريخ الأحداث: Date Created: 20210515 Date Completed: 20211025 Latest Revision: 20211025
رمز التحديث: 20231215
DOI: 10.1016/j.ajem.2021.04.079
PMID: 33991972
قاعدة البيانات: MEDLINE
الوصف
تدمد:1532-8171
DOI:10.1016/j.ajem.2021.04.079