Mr. Johnson is 58 years old, has hypertension and diabetes, and presents with atypical chest pain that merits evaluation for possible troubled blood flow to the heart. With the evolution of insurance denials and preauthorization, we as clinicians have to consider the multitude of factors that will eventually determine if and how much of his care would be covered. We look at overall risk to help determine whether he goes home to get outpatient follow up, we admit him to the outpatient designation of observation status, or we check that he meets the criteria for inpatient admission.
In Mr. Johnson’s case, there is no reason for inpatient admission, but his risk is high enough we want to bring him into the hospital for monitoring. This admission is categorized as outpatient status and termed observation. Why is this important? This designation has ramifications beyond just the monetary, which includes how little will be paid for his time in the hospital and how much more of that Mr. Johnson has to pay out of pocket.
The observation status stays are measured in hours rather than days, which is how inpatient stays are measured. This often-overlooked difference can make or break a hospital’s overall flow. Imagine if Mr. Johnson is admitted to the medical unit and assigned to a team that has patients here for a variety of inpatient reasons. These patients have higher acuity and are more likely to require the attention of the clinicians and nurses, leaving Mr. Johnson’s hour-by-hour ticking.
Enter the short-stay unit, a place with space, people and processes designed to support Mr. Johnson on his care journey. Protocols are in place, everyone’s clock is on the hour-by-hour pace and resources are aligned.
It should be no surprise that in this setting, we see dramatic decreases in total hours that patients linger in the hospital. We can aim to get Mr. Johnson’s care and next steps delineated within 24 hours. In contrast, amid the inpatient units, this could be 48 or even 72 hours.
Administrators probably recognize that with 20% to 30% of hospitalizations being observation, saving one to two inpatient unit bed days per case could dramatically change the flow in the hospital and in the emergency department.
Additional benefits that have been reported include improved patient experience and outcomes. Patients in short-stay units report higher satisfaction levels compared to those in traditional inpatient settings. Key factors include shorter wait times, more personalized care and reduced uncertainty about stay duration.
Short-stay units provide a less congested environment, allowing for individualized attention and quicker decision-making. Moreover, some research indicates that observation units can lead to better clinical outcomes than inpatient units. For instance, patients in one short-stay unit experienced fewer adverse events compared to those admitted to inpatient units. And at the end of the day, fewer days in the hospital reduces risks for hospital acquired conditions.
Keys to Success
Have dedicated hospitalists and multidisciplinary teams.
Hospitalists are crucial to the successful operation of short-stay units. Their expertise in inpatient care, including the management of acute conditions, care coordination and discharge planning, makes them well-suited for these collaborations. Hospitalists' skills in coordinating care, adhering to clinical guidelines and communicating effectively with patients and other healthcare providers enhance the quality and efficiency of short-stay units. Their ability to analyze data and track performance metrics further optimizes functioning, improving patient outcomes and operational efficiency. With the protocolized care, these units are a great place for our nurse practitioners and physician assistants to excel and work at top of license.
Develop a smart design.
To maximize the benefits of short-stay units, hospitals should focus on clear selection criteria, effective protocols, well-designed physical spaces and performance tracking. Monitoring metrics such as volume, efficiency and conversion rates to inpatient care is crucial for continuous improvement and flow. While these locations address many challenges in patient flow and cost management, they require efficient and collaborative design and operation.
This model offers a strategic solution to the challenges posed by observation status patients, providing both clinical and operational advantages. By streamlining care through dedicated hospitalist teams, optimized protocols and tailored environments, hospitals can improve patient outcomes, enhance satisfaction, and maximize resource efficiency.
Short-stay units not only help reduce inpatient bed days but also alleviate strain on emergency departments and inpatient units, contributing to smoother hospital operations overall. Embracing this model could be a key driver for hospitals aiming to improve both patient care and operational flow.
Rachel Thompson, MD, SFHM, FACP, is CMO, Core Clinical Partners.
A Premier Corporate Partner of ACHE, Core Clinical Partners, a practice management organization specializing in emergency and hospital medicine, offers clinician outsourcing, clinician insourcing, revenue cycle management and healthcare consulting. For more information, visit ache.org/Core.