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From left: Heidi Crim, of BWH's Emergency Department, and Christopher Baugh and Jenny Andrews, of Emergency Medicine
In the past few years, the number of observation patients-people who are not well enough to go home but not sick enough to be admitted as inpatients-has increased at BWH and nationwide.
In an effort to better match these patients with their care needs, a new Emergency Department (ED) observation unit opened on Tower 12D last week, providing an extension of BWH's existing 10-room observation unit located within the ED, which was created in 1996.
Christopher Baugh, MD, MBA, of BWH Emergency Medicine, believes the rising numbers of observation status patients can be explained by several reasons, including recent health insurance policy changes focused on making short hospitalizations more efficient, as well as an aging population. Older patients are often more medically complex and face chronic health issues, such as chest pain, digestive issues or nutritional disorders, but may not need an inpatient admission to receive proper care. Such patients are challenging to manage within the time and resource constraints of an ED visit, so an observation unit provides another option for those who cannot be safely discharged home after their initial evaluation.
"These patients may have difficulties with activities of daily living or be at increased risk for falls," said Baugh. "They may be experiencing psychosocial issues; they are a vulnerable population. We're matching patients with the resources they need, which is a win-win for patients and the hospital."
The new remote observation unit consists of 10 private rooms staffed by ED nurses, medical assistants, physician assistants and care facilitators, with an ED attending rounding every morning and at other times throughout the day and night. The pod increases the capacity of the existing ED observation unit to care for more observation patients, while opening up space on inpatient units for patients who require admission due to more complicated needs. Additionally, getting observation patients the most appropriate care faster decreases their length-of-stay.
"This new unit will allow us to provide the best and most efficient care to this important and incredibly diverse population of patients," said Ron Walls, MD, chairman of Emergency Medicine.
Baugh says ED care providers are specifically well-equipped to care for observation patients.
"The culture of the ED is one of constant reevaluation and rounding, and teams are used to patients coming and going at all hours," he said. "There are particular assessment skills ED physicians and nurses are trained to use-including phlebotomy on demand-which best serve these patients. ED staff are also comfortable caring for patients with a wide variety of issues, both medical and surgical."
Financially, the new unit also makes sense. Medicare reimburses about $3,000 less for observation than for short inpatient stays since resource needs are less.
"Over the past several months, we've met with the services that will be integral to successfully operating this new unit," said Heidi Crim, RN, MSN, nursing director for the Emergency Department. "The level of collegiality bestowed to us has been nothing short of remarkable-each department and service has been eager to revise workflows and processes in order to ensure that patients continue to receive timely, high-quality patient care. We are very grateful to the hospital for the support we've received throughout this process."