2.50
Hdl Handle:
http://hdl.handle.net/10755/162549
Type:
Presentation
Title:
Clinical Decision Units: More than Just Emergency Department Holding Areas
Abstract:
Clinical Decision Units: More than Just Emergency Department Holding Areas
Conference Sponsor:Emergency Nurses Association
Conference Year:2009
Author:Streets, Kara W., RN, MS, CEN
P.I. Institution Name:Christiana Care Health Systems
Title:Nurse Manager
Contact Address:4755 Ogletown-Stanton Rd., Newark, DE, 19718, USA
Contact Telephone:302-733-2229
Co-Authors:Sharon M. Vickers, RN, MSN; Donna D. Mahoney, BS, CPHQ
[Annual Conference] Clinical Topic: A multidisciplinary team of physicians and nurses were convened to address the following data abstracted from a 700+ bed east coast level one trauma center's internally developed data warehouse. From November 2006 to April 2007, the emergency department (ED) experienced ED and inpatient over-crowding, resulting in a weekly average of more than 480 admitted patients boarding in the ED for over 2100 hours. In addition, approximately 65 cardiac/medical patients per month were appropriately admitted in an observation status.

Implementation: Following nationally published best practices; the team developed a clinical decision unit (CDU) and based it directly behind the emergency department. Evidence-based best practice founded the guidelines for the 16 selected diagnoses, 4 cardiac, 10 medical and 2 trauma and their corresponding order sets. The unit was staffed with nurse practitioners, nursing, clerical and technician staff trained to care for short stay potentially high acuity patients.

Outcomes: Eighteen months after implementing the CDU, the number of observation patients admitted through the ED increased by more than 400%. Of all observation patients, 69%were placed in the CDU resulting in an 8% decrease in the overall number of patients boarding in the ED and a 48% decrease in ED boarding hours. This decrease assisted the ED in achieving its goal of fewer than 1000 patient boarding hours per week for 28 weeks in FY08 compared to only 10 weeks in FY07. Sixty four percent of CDU observation patients boarded in the ED for an average of 1.21 hours while 81% of non-CDU observation patients boarded for an average of 2.13 hours. The length of stay goal of the CDU is fewer than 18 hours. The number of patients being discharged in less than 23 hours has increased by 32% and the number of patients staying longer than 36 hours has decreased by 57%. The five highest patient admission diagnoses placed in the CDU have an average length of stay of 10.5 hours less than if placed elsewhere within the institution.

Recommendations: During times of low census, the CDU became creative in the utilization of its unoccupied beds. An overflow outpatient infusion service has been implemented to compliment the observation diagnoses accepted into the CDU. This service serves 2 purposes; 1) it allows overflow outpatient infusion patients to be cared for within the institution in a timely manner and 2) opens inpatient beds for appropriate placement of patients admitted to the institution but boarding in the ED. Additional diagnoses are being evaluated to be incorporated into the unit's operation. Evidence based best practice shows that keeping patients with similar diagnoses with staff who specialize in their care produces optimal patient outcomes. Keeping the emergency department staff educated in observation care allows the right patient to be placed in the right bed to receive the most optimal care thereby promoting optimal patient outcomes.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleClinical Decision Units: More than Just Emergency Department Holding Areasen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162549-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Clinical Decision Units: More than Just Emergency Department Holding Areas</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2009</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Streets, Kara W., RN, MS, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Christiana Care Health Systems</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Nurse Manager</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">4755 Ogletown-Stanton Rd., Newark, DE, 19718, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">302-733-2229</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">kstreetsedrn@verizon.net</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Sharon M. Vickers, RN, MSN; Donna D. Mahoney, BS, CPHQ</td></tr><tr><td colspan="2" class="item-abstract">[Annual Conference] Clinical Topic: A multidisciplinary team of physicians and nurses were convened to address the following data abstracted from a 700+ bed east coast level one trauma center's internally developed data warehouse. From November 2006 to April 2007, the emergency department (ED) experienced ED and inpatient over-crowding, resulting in a weekly average of more than 480 admitted patients boarding in the ED for over 2100 hours. In addition, approximately 65 cardiac/medical patients per month were appropriately admitted in an observation status. <br/><br/>Implementation: Following nationally published best practices; the team developed a clinical decision unit (CDU) and based it directly behind the emergency department. Evidence-based best practice founded the guidelines for the 16 selected diagnoses, 4 cardiac, 10 medical and 2 trauma and their corresponding order sets. The unit was staffed with nurse practitioners, nursing, clerical and technician staff trained to care for short stay potentially high acuity patients.<br/><br/>Outcomes: Eighteen months after implementing the CDU, the number of observation patients admitted through the ED increased by more than 400%. Of all observation patients, 69%were placed in the CDU resulting in an 8% decrease in the overall number of patients boarding in the ED and a 48% decrease in ED boarding hours. This decrease assisted the ED in achieving its goal of fewer than 1000 patient boarding hours per week for 28 weeks in FY08 compared to only 10 weeks in FY07. Sixty four percent of CDU observation patients boarded in the ED for an average of 1.21 hours while 81% of non-CDU observation patients boarded for an average of 2.13 hours. The length of stay goal of the CDU is fewer than 18 hours. The number of patients being discharged in less than 23 hours has increased by 32% and the number of patients staying longer than 36 hours has decreased by 57%. The five highest patient admission diagnoses placed in the CDU have an average length of stay of 10.5 hours less than if placed elsewhere within the institution.<br/><br/>Recommendations: During times of low census, the CDU became creative in the utilization of its unoccupied beds. An overflow outpatient infusion service has been implemented to compliment the observation diagnoses accepted into the CDU. This service serves 2 purposes; 1) it allows overflow outpatient infusion patients to be cared for within the institution in a timely manner and 2) opens inpatient beds for appropriate placement of patients admitted to the institution but boarding in the ED. Additional diagnoses are being evaluated to be incorporated into the unit's operation. Evidence based best practice shows that keeping patients with similar diagnoses with staff who specialize in their care produces optimal patient outcomes. Keeping the emergency department staff educated in observation care allows the right patient to be placed in the right bed to receive the most optimal care thereby promoting optimal patient outcomes.<br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:30:04Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:30:04Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.