The Grapevine

Designating Space For Less Acute Cases In Emergency Units Optimizes Hospital Resources

In times of outbreaks and emergencies, the emergency units are needed to urgently address acute cases while offering accurate and quick treatment to the less severe cases, so as to provide adequate health care to everyone, irrespective of seriousness. A strain is put on hospital resources, financially and materially, during the winter season with the significant hike in the number of flu cases. 

A study conducted by Icahn School of Medicine at Mount Sinai in New York proposed a practical solution. The report published in BMJ Open Quality last week highlighted the positive changes of adding a pediatric observation unit (POU) next to the pediatric emergency department (PED), which is already in existence. 

The arrangement was implemented in Mount Sinai Beth Israel in New York in an effort to improve patient outcomes and satisfaction, and increase the efficient provision of timely health care. During the study period between January 2017 and December 2018, 777 children received treatment at the newly designed POU. Majority of the admissions were for children who were suffering from respiratory illnesses. 

"We found that continuous quality improvement of admissions tracking really helped us optimize resources in our ED, with our initial, first priority being admissions for respiratory conditions," C. Anthoney Lim, lead author and director of Pediatric Emergency Medicine for the Mount Sinai Health System, said, as quoted in the news release.

"An example of such refinements would be the admission of patients requiring continuous albuterol for children with respiratory distress to the POU instead of directing them to the PICU."

What The Study Found

The team of emergency medical personnel studied the limited length of stay for patients treated at the pediatric observation unit (POU). Their aim was to bring down the stay to less than two whole days. The results were positive.“The average length of stay (LOS) was 25.7 hours in 2017 and 26.5 hours in 2018,” the researchers stated in the paper. 

Additionally, they wanted to ensure these limited stays were not unnecessarily converted to inpatient hospitalizations by bringing down the conversion rate to 15 percent. This was to prevent squandering the increase in reimbursement generated from accommodating more patients.

The conversion rate improved within the first year at 18.7 percent. However, in 2018, the rate exceeded their expectations by bringing it down to 13.1 percent. 

"Our experience demonstrates that the combined model can provide pediatric emergency care to families while avoiding the need to admit up to 70 percent of children to pediatric inpatient units," Dr. Lim added. 

A pediatrician examins a boy. A pediatrician examins a boy. weallfallapart/Flickr