"Short of the emergency department or an emergency test, our unit gets testing priority over everything else in the hospital. The goal is that testing and reporting gets done quickly, so we can either order more testing or be ready to discharge the patient," she says.
Moving quickly and sound decision-making are primary factors that shorten a patient's length of stay in the observation unit, Baker says.
"The way we keep length of stay down is by seeing the patient quickly, ordering appropriate and prioritized testing, and making decisions with swiftness based on testing or whether the patient needs treatment," she says.
Timeliness is essential for the clinicians working in the observation unit, she says. "You have to monitor your time: rounding frequently, engaging the nurses to be more proactive, and making sure you are communicating well with the ancillary staff and case managers."
Another key to lowering length of stay is judicious use of specialist consults. "That keeps your length of stay down because the consultants are not always in the hospital during the day. Even if they are trying to prioritize your patients, they often can't because they are usually seeing their outpatient-practice patients," she says.
Limiting consultations and lab testing is done without compromising quality, Baker says. "We make sure we are practicing based on best practices. We are not over-testing and we are not under-testing just because we are worried about length of stay."
From August 2016 to February 2018, length of stay in the observation unit has fallen from 29.0 hours to 20.7 hours.
The observation unit is generating a positive return on investment, including helping the LifeBridge Health hospital avoid readmissions penalties, Baker says. "Making sure the patients are being treated appropriately and not coming back to the hospital has huge return on investment," she says.
Personnel has been the highest cost in operating the observation unit, but staffing with a relatively high number of physician assistants and nurse practitioners has helped curb spending, she says. "To keep costs down, physician assistants and nurse practitioners are fabulous."
Christopher Cheney is the senior clinical care editor at HealthLeaders.