As Emergency Departments (EDs) across the country are facing space, resource and staffing shortages, health systems are building Clinical Decision Units, or Observation Units, to help alleviate these stresses. Observation Units provide treatment and monitoring for patients who need further evaluation to determine whether they meet admission criteria. With Observation Units joining EDs, inpatient hospitalization rates are likely to decline as the healthcare industry reacts to new admission regulations required by the Centers for Medicare and Medicaid Services (CMS).
Array recently completed two Observation Units for Mount Sinai Health System’s Roosevelt and St. Luke’s Hospitals, both located in New York City. The design intent was to bring the new Observation Units, which were formally inpatient bed units, into compliance with the 2010 Guidelines for Healthcare Facilities. The conversion from an inpatient bed unit into an Observation Unit required the addition of new nurse stations. Modifying existing toilets provided full compliance with ADA requirements for accessible toilets and shower rooms. New wardrobes, medical equipment, additional power and oxygen outlets were added to complete the new Observation Units with as minimal disturbance to adjacent areas as possible during construction.
Overall, the conversion was slight in terms of construction disturbance to adjacent units, schedule and costs, while the gains from the unit can stand to be great. ED resources will not be stretched as thin, providing both a better patient and staff experience. Patient care will improve, as specialized attention will be given within the Observation Unit as opposed to transferring patients to an inpatient unit serving patients that are more acute. An added patient benefit will be the lessened chance to contract hospital-based illnesses due to a reduction in patient transport.
Hospital administrators, admission staff and billing personnel need to be aware of the CMS’ recently amended laws that dictate the “two-midnight rule.” Though a patient’s injury/illness may require hospitalization, it does not guarantee admittance to the hospital as an inpatient right away due to new CMS hospital admission requirements, which require a patient to meet certain criteria prior to admittance.
Instead, if an injury or illness does not present an immediate need for hospitalization but may warrant treatment, the patient will spend the night in the Observation Unit as an outpatient for further monitoring. Care needs to be taken to track the patient’s entry time through the ED, their diagnosis in the Observation Unit, and the admission or discharge plan.
For hospitals that have the physical and operational capacities to add Observation Units, high quality and efficient care as a result can help lessen the burden and are an ideal solution for an overwhelmed ED.
