Observation unit saves $567/patient
February 1, 1998 2 minutes read
Observation unit saves $567/patient
Admitting patients is more costly
There’s always a concern that a chest pain patient who is sent home should have been hospitalized, and a hospitalized patient should have gone home. Both scenarios not only carry patient care and ethical implications, but can add to cost depending upon outcomes.
The concerns can be ameliorated by an alternative patients who might otherwise be sent home directly from the emergency department (ED) are sent to an observation unit. (See Cost Management in Cardiac Care, August 1997, p. 93.) There it may be determined that they need hospitalization anyway for an acute myocardial infarction (AMI) or other condition, or they are discharged. Consider this recent study, just one of many clinical trials going on today that show substantial savings for observation units.
Cook County Hospital in Chicago compared costs of an ED-based accelerated diagnostic protocol with hospitalization.1 Investigators wanted to determine whether use of an observation unit could reduce hospital admission rates, total costs, and lengths of stay for chest pain patients ultimately needing admission. Mean costs and lengths of stay of all patients randomized to the unit, including those subsequently hospitalized, were lower than mean costs and lengths of stay for those randomized to the hospital.
They concluded that the observation unit patients cost $1,528 vs. $2,095 for the admitted patients. Utilizing the observation unit saved $567 in total hospital costs per patient treated, and no deaths or complications occurred among those patients. The $567 savings translates into $238 million annually. Observation unit patients spend fewer hours in the hospital 33.1 vs. 44.8 and the hospital didn’t have to go to the trouble of admitting and discharging.
Another study concluding that a rapid protocol in an observation unit was more cost-effective than routine hospital care was conducted by the Rapidly Ruling Out Myocardial Ischemia (ROMIO) investigators who randomized participants to admit or observation in a chest pain unit.2 o diagnoses were missed. The patients’ average lengths of stay were 12 hours in the observation unit as compared to 24 in the hospital. The initial cost was $893 for the ED and $1,349 for the hospital, and 30-day charges were $898 and $1,522.
While chest pain is the chief complaint presenting to the ED, and 60% of people presenting are admitted, AMI’s missed diagnosis is the No. 1 malpractice problem. AMI consumes an estimated 39% of the malpractice dollar.
Your facility might have an outpatient observation unit that uses accelerated protocols to diagnose myocardial ischemia among low-risk patients. It may variously be called a rapid treatment center, a clinical decision unit, or a rule-out-AMI unit. An estimated 27% of the nation’s hospitals have such an area, and 2% to 6% of patients seen in the ED are transferred there.
References
1. Roberts RR, Zalenski RJ, Mensah EK, et al. Costs of an emergency department-based accelerated diagnostic protocol vs hospitalization in patients with chest pain. JAMA 1997; 278:1,670-1,676.
2. Gomez MA, Anderson JL, Karagouniet LA, et al. An emergency department-based protocol for rapidly ruling out myocardial ischemia reduces hospital time and expense (ROMIO). J Am Coll Cardio 1996; 28:25-28.
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