Hospitals are focusing more on patient admission status as inpatient or observation due to changes in reimbursement and increased scrutiny from regulatory agencies. Observation units allow for more efficient and appropriate care for patients admitted under observation status. Implementation of these units may decrease resource utilization, length of stay (LOS) and costs.
We compared data of patients admitted under observation status either to the general floor in Quarter 4 of 2009 or to the observation unit in Quarter 4 of 2010. The data was obtained from our administrative database and included primary diagnosis, LOS and total charges. We excluded patients who were classified as inpatient at any time during the admission, regardless of the patients’ length of stay. All patients were cared for by a hospitalist. Patient cohorts were compared overall and then by primary diagnosis: chest pain, syncope and abdominal pain. Continuous variables were compared using the Student’s ttest. Dichotomous variables were compared using the chisquare test. All data was analyzed using Stata 11, College Station, TX and Microsoft Excel.
The overall mean LOS significantly decreased in the OBS unit (19.04 hours vs. 29.55 hours, P<0.001). Overall mean total charges also significantly decreased ($7,230 vs. $8,709, P<0.001). The percentage of patients staying beyond 24 hours was reduced from 42.9% baseline to 21.9% post implementation of the OBS unit (P<0.001). In chest pain patients, significant decreases were seen in LOS (17.92 hours vs. 26.71 hours, P<0.001) and total charges ($7,157 vs. $8,920, P<0.001). Significantly fewer patients were hospitalized for more than 24 hours (19.5 % vs. 35.7%, P<0.001). In syncope patients, LOS for patients admitted to the OBS unit significantly decreased (23.00 hours vs. 43.44 hours, P<0.05). There was no significant difference in total charges but a significantly lower proportion were hospitalized for more than 24 hours (28.7% vs. 66.6%, P=0.003). In abdominal pain patients, no statistically significant differences were seen any in of the metrics. Readmission rates were negligible both pre and post implementation.
There was an improvement in overall LOS, total charges and percentage of patients staying longer than 24 hours. In subgroup analyses, patients admitted with chest pain or syncope had a significant reduction in all metrics. The lack of effect in abdominal pain patients is likely due to small sample size and variability in clinical presentation and evaluation needs. Our comparison shows that implementation of an observation unit improves key metrics in hospital efficiency without affecting readmission rates. Additional studies are needed to assess other metrics such as patient satisfaction, ER throughput of patients admitted to the observation unit, effects of incorporating case managers into the triaging process to determine admission classification, and the use of standardized clinical protocols.
To cite this abstract:Ansari A, Schulwolf E. Impact on Length of Stay and Costs in Patients Admitted to an Observation Unit with Chest Pain, Syncope and Abdominal Pain. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97655. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/impact-on-length-of-stay-and-costs-in-patients-admitted-to-an-observation-unit-with-chest-pain-syncope-and-abdominal-pain/. Accessed April 21, 2019.