ED Observation Unit provides the right care at the right time

ED Observation Unit provides the right care at the right time

At Christiana Hospital, a nimble, dedicated team cares for patients whose health concerns clearly warrant emergency care but whose need for hospital admission is not as obvious.

The Emergency Department Observation (ED OBS) Unit is a 12-bed unit adjacent to the Christiana Hospital Emergency Department that recently finished its first full year of caring for patients. The patients who arrive there do not need to be admitted but are in need of care that goes beyond the initial evaluation and management of an emergency care setting.

“We care for the large proportion of Emergency Department patients who benefit from an extended observation period,” said Jason Nace, M.D., medical director of the ED OBS Unit. “By identifying patients who are the right candidates for our unit, we are supporting our Emergency Department colleagues by freeing up space and resources so they can focus on the care of patients in need of emergency services. We also are supporting our colleagues on the inpatient units by enabling them to save hospital beds for patients who truly need to be admitted.”

Jacqueline Malantonio, RN, and Jill Jensen, APN, transport a patient from the Emergency Department to the Observation Unit. By going directly to the patient and having a handoff conversation with ED staff, the ED-OBS team ensures speedy, safe patient care.
Jacqueline Malantonio, RN, and Jill Jensen, APN, transport a patient from the Emergency Department to the Observation Unit. By going directly to the patient and having a handoff conversation with ED staff, the ED-OBS team ensures speedy, safe patient care.

Not every hospital has an emergency department observation unit. The value of ED observation units is gaining traction nationwide as they demonstrate success in treating patients and reducing health care costs. An article in the October 2012 issue of the journal Health Affairs stated that if hospitals without dedicated observation units began using them for their short-stay patients, the move could save as much as $3.1 billion in U.S. health care dollars per year.

ED OBS Units see patients with common health concerns such as fainting, fluid and electrolyte disorders, and abdominal pain. Christiana Care’s ED OBS Unit sees patients with those conditions as well as skin and kidney infections, and concussions. The unit also assists patients in need of ambulatory infusion services. Patients with heart issues that warrant observation care are seen separately in Christiana Hospital’s Cardiac Short Stay Unit.

Unit Clerk Bryan Huff schedules an infusion for a patient in the ED Observation Unit. Having staff trained with a variety of skills helps the unit to be nimble in caring for their patients.
Unit Clerk Bryan Huff schedules an infusion for a patient in the ED Observation Unit. Having staff trained with a variety of skills helps the unit to be nimble in caring for their patients.

Christiana Care’s ED OBS Unit uses a coordinated approach that is grounded in partnerships among staff and patients to accelerate the delivery of expert, value-based care and reduce length of stay for patients who pass through Christiana Hospital’s Emergency Department, which, with more than 120,000 visits each year, is one of the nation’s busiest. As soon as Emergency Department staff identify a patient who could benefit from extended observation, the ED OBS Unit staff goes directly to the patient. The Emergency Department staff, ED OBS staff and the patient have a discussion at the bedside to ensure a safe handoff, and then the patient is brought to the ED OBS Unit to be monitored and treated over the next several hours.

The ED-OBS care team helps to safely move a patient from a stretcher to a bed upon arrival at the Observation Unit.
The ED-OBS care team helps to safely move a patient from a stretcher to a bed upon arrival at the Observation Unit.

The ED OBS Unit is the only unit in the health system managed round-the-clock by advanced practice nurses, meaning that changes to the medical management of the patient can be made quickly as the patient’s clinical status changes. Patients who are in need of services that don’t necessarily require them to be admitted, such as physical therapy, antibiotics or lab tests, can receive them in the observation unit.

The ED OBS nurses are trained in advanced cardiac life support care and have special training to meet the needs of the unique ED OBS population, including administration and titration of higher-level medications. The patient care techs on the team are trained in emergency care skills such as phlebotomy, EKG testing and teaching patients how to properly use crutches. The unit clerks also are certified in CPR and Patient Equipment Environment Posture Safety (PEEPS) training.

More than 270 of the 320 patients seen each month in the ED OBS Unit are discharged within 24 hours. Most patients are discharged within 16 hours.

“We strive to get our patients out as quickly and as safely as possible,” said Sharon Vickers, RN, MSN, CEN, ED OBS Unit staff development specialist.

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