Admission/Discharge/Observation Unit: Surviving Emergency Department Overcrowding

2.50
Hdl Handle:
http://hdl.handle.net/10755/163026
Type:
Presentation
Title:
Admission/Discharge/Observation Unit: Surviving Emergency Department Overcrowding
Abstract:
Admission/Discharge/Observation Unit: Surviving Emergency Department Overcrowding
Conference Sponsor:Emergency Nurses Association
Conference Year:2004
Author:Presley, Diane, RN, MSN
Contact Address:9000 LaSiesta Bend, Austin, TX, 78749, USA
Contact Telephone:(512) 922-3125
Co-Authors:Diane Presley, RN, MSN
Purpose: Emergency department (ED) visits have increased markedly since the early- to mid-1990s. The increased demand and higher medical complexity of patients has contributed to ED overcrowding. Longer waiting times, unpleasant therapeutic environments (e.g., hallway stretchers), decreased patient and staff satisfaction, and poor clinical outcomes may result. In the attempt to decrease ED overcrowding, an admission discharge observation unit (ADOU) was developed and instituted. Design/setting: This retrospective descriptive study concerning process improvement was conducted in a Level II emergency department in the mid-south United States. Methods: The institution?s ED leadership team created a steering committee of directors, managers, and staff from a cross-section of in-patient units and emergency services staff and physicians. The team objectives were: 1) Create admission/discharge/observation criteria; 2) Obtain approval from senior leadership and medical staff; 3) Develop care paths for target diagnoses; 4) Establish a plan area for treatment; 5) Recommend staffing mix/levels for optimal care;
6) Process direct admissions via the unit when in-patient beds are unavailable; and 7) Address conditions that are less-successfully treated in the emergency department, but can be successfully treated with an additional 10 to 15 hours of observational status. These conditions include dyspnea, asthma, wheezing, COPD (acute exacerbated), simple pneumonia, congestive heart failure, syncope/TIA, non-specific abdominal pain, and postoperative patients who have inability to void, excessive nausea/vomiting, excessive pain, or who do not score on the Post Anesthesia Recovery (PAR) scale for post-sedation response. Results: The outcomes of the project included more cost-effective care; the avoidance of unnecessary in-patient admission, which decompresses ED volume by 20 patients daily; and the opportunity to institute pathways and standardize care. Direct admissions bypassed the emergency department completely, with an average volume of six per day. Care risks were eliminated and patient satisfaction and education was increased. Emergency department staff satisfaction and retention increased. The ADOU program met the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requirements for the ED Overcrowding Standard.
Recommendations: The incorporation of ADOUs can serve patients with diverse clinical syndromes, reduce ED overcrowding, and eliminate unnecessary hospital admissions. A rigorous quality program evaluates the appropriateness of admission and the scope of care delivered, and provides continual process improvement.
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.titleAdmission/Discharge/Observation Unit: Surviving Emergency Department Overcrowdingen_GB
dc.identifier.urihttp://hdl.handle.net/10755/163026-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Admission/Discharge/Observation Unit: Surviving Emergency Department Overcrowding</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">2004</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Presley, Diane, RN, MSN</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">9000 LaSiesta Bend, Austin, TX, 78749, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(512) 922-3125</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">predia608@skmc.gov.ae</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Diane Presley, RN, MSN</td></tr><tr><td colspan="2" class="item-abstract">Purpose: Emergency department (ED) visits have increased markedly since the early- to mid-1990s. The increased demand and higher medical complexity of patients has contributed to ED overcrowding. Longer waiting times, unpleasant therapeutic environments (e.g., hallway stretchers), decreased patient and staff satisfaction, and poor clinical outcomes may result. In the attempt to decrease ED overcrowding, an admission discharge observation unit (ADOU) was developed and instituted. Design/setting: This retrospective descriptive study concerning process improvement was conducted in a Level II emergency department in the mid-south United States. Methods: The institution?s ED leadership team created a steering committee of directors, managers, and staff from a cross-section of in-patient units and emergency services staff and physicians. The team objectives were: 1) Create admission/discharge/observation criteria; 2) Obtain approval from senior leadership and medical staff; 3) Develop care paths for target diagnoses; 4) Establish a plan area for treatment; 5) Recommend staffing mix/levels for optimal care;<br/>6) Process direct admissions via the unit when in-patient beds are unavailable; and 7) Address conditions that are less-successfully treated in the emergency department, but can be successfully treated with an additional 10 to 15 hours of observational status. These conditions include dyspnea, asthma, wheezing, COPD (acute exacerbated), simple pneumonia, congestive heart failure, syncope/TIA, non-specific abdominal pain, and postoperative patients who have inability to void, excessive nausea/vomiting, excessive pain, or who do not score on the Post Anesthesia Recovery (PAR) scale for post-sedation response. Results: The outcomes of the project included more cost-effective care; the avoidance of unnecessary in-patient admission, which decompresses ED volume by 20 patients daily; and the opportunity to institute pathways and standardize care. Direct admissions bypassed the emergency department completely, with an average volume of six per day. Care risks were eliminated and patient satisfaction and education was increased. Emergency department staff satisfaction and retention increased. The ADOU program met the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requirements for the ED Overcrowding Standard.<br/>Recommendations: The incorporation of ADOUs can serve patients with diverse clinical syndromes, reduce ED overcrowding, and eliminate unnecessary hospital admissions. A rigorous quality program evaluates the appropriateness of admission and the scope of care delivered, and provides continual process improvement.</td></tr></table>en_GB
dc.date.available2011-10-27T10:38:16Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:38:16Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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