Protocol-driven ED observation units save money & time

Using standardized protocols during dedicated emergency department (ED) observation visits may be cheaper and result in shorter stays and fewer admissions, according to a study published in the December issue of Health Affairs.

As a result of new reimbursement rules, a growing trend in emergency departments is the use of observation services, which means patients who are not well enough for discharge but also not sick enough for hospital admission are treated as outpatients in ED observation areas. These types of patients are not expected to stay more than 24 hours.

About one-third of U.S. EDs have observation units in place, and half of them use protocols specific to different conditions, known as type 1 settings. EDs with no such protocols are known as type 2 settings. Key elements of type 1 settings include the specific protocols, a dedicated unit, adequate staffing, a focus on metrics and quality measures, operational guidelines and support services.

To evaluate the impact of each type of setting on length of stay, cost and admission, investigators led by Michael A. Ross, MD, of Emory University in Atlanta, compared 2010 data from a case study of three type 1 observation units in Atlanta, statewide discharge data from the four types of observation units and national discharge data from the four types of observation units.

Patients who received care in a type 1 unit had a 23 to 38 percent shorter length of stay and a 17 to 44 percent lower chance of hospital admission. This type of care also potentially saved $950 million. They also estimated that 11.7 percent of inpatients who have short hospital admissions could be treated in type 1 ED units, which could save $8.5 billion a year.

Based on their analysis, the investigators urged lawmakers to reward the use of this type of setting.

“Policy makers should have hospitals report the setting in which observation services are provided and consider payment incentives for care in a type 1 unit,” they wrote.