Maximizing use of the emergency department observation unit: A novel hybrid design

Study objective: We sought to determine whether sharing an observation unit with scheduled procedure patients would maintain a more consistent unit ce nsus and patient/nurse ratio. A secondary objective was to determine the ef fect of this model on patient length of stay and discharge rates. Methods: This retrospective, descriptive study was conducted in a high-volu me suburban teaching hospital, using a "before-and-after" study design, A " pure" postprocedure unit became a "hybrid" observation postprocedure unit b y displacing specific postprocedure patients to inpatient locations. Subseq uently, the displaced patients were returned to the unit. On weekends, the unit operated as a pure observation unit. Hourly unit occupancy and census data were prospectively collected, and hourly patient/ nurse ratios were ca lculated. Patient length of stay and dis charge data were collected and com pared in different settings. Results: The 2 services showed a complementary census pattern that allowed the hybrid unit to maintain an average hourly patient/nurse ratio of 3.7 co mpared with the ratio of 2.5 for a pure observation unit. There was no diff erence in observation patient length of stay(14.8 hours versus 14.7 hours) or discharge rate (20.4% versus 18.1%) between weekdays and weekends. Howev er, scheduled procedure patients experienced significantly shorter lengths of stay in the hybrid unit setting (4.3 hours) than in alternative inpatien t locations (9.4 hours). Conclusion: The hybrid model showed better hourly census and nurse resource use rates, with no adverse effect on observation patients. However, schedu led procedure patient length of stay was shorter in this setting.