From left, Jim Traylor, emergency department nursing manager, and Dr. Chris Ross, emergency department physician, pose in one of the new clinical decision unit rooms at Community Hospital South. The unit was created to house patients who needed further observation after an emergency, but not necessarily ready for admission to the hospital.
Sometimes, doctors simply need more time.
When a patient comes to the emergency room, their stay is not intended to last more than a few hours before they’re released. But often, that short time is not adequate to allow doctors to ensure all is well with the patient.
Maybe they need more observation after experiencing chest pains or stroke symptoms. The patients could require additional testing, or doctors think they could benefit from more treatment.
“Sometimes, providers have a patient where they don’t necessarily want to admit them, but they’d hate to send them home right now,” said Jim Traylor, emergency department nursing manager at Community Hospital South.
The southside hospital has unveiled its newest addition to best treat patients who come to the emergency room. The clinical decision unit is a separate eight-bed space serving patients who need additional care after an emergency, but do not necessarily need to be admitted to the hospital.
The goal is to provide patients with a more efficient and safe treatment, while giving physicians more flexibility to help a variety of different conditions.
“We wanted to create a more efficient way of getting them effective treatment and getting them home and better quicker,” said Dr. Chris Ross, an emergency department physician at Community Hospital South.
In a wing off Community Hospital South’s emergency room, patients pass through a doorway marked with “CDU” in huge letters.
Glass-walled rooms line the curved corridor. Inside each one, patients have a hospital bed, monitoring equipment and wood paneled cabinets for supplies. Flat screen televisions are mounted in every room, and a curtain can be pulled in front of the door and glass windows for additional privacy.
At the center of the unit, a station allows physicians and nurses specifically assigned to the patients to monitor and attend to them as necessary. Staff is on call 24 hours a day, so patients can get their needs met quickly, then be discharged home, Ross said.
“People are literally across the hallway from where their caregivers are, which is a nice convenience if they need something,” he said.
Clinical decision, or observation, units have become increasingly common across the United States as hospitals look for ways to improve treatment methods and flow of patients through the emergency department. The practice of having the observation started in the 1960s, as a way to keep an eye on patients who were having cardiovascular distress.
The usage has grown, with more protocol-driven programs to best operate the units.
The American College of Emergency Physicians has called the units a “best practice” According to research published in the journal Health Affairs, patients who received treatment in a protocol-driven clinical decision or observation unit had a 38% shorter stay than patients who did not. The average cost savings was $1,572 per patient.
For leaders at Community Health Network, adding such a unit at Community Hospital South was a matter of adapting to patients’ needs here in the area.
The demand for hospital beds, not only in the emergency department but throughout the entire hospital, is always growing, and more and more people need health care, Traylor said.
“The southside is growing by leaps and bounds. We’re really looking at that and anticipating that growth,” he said.
The rooms are not designed for extended treatment — the average length of stay is 15 hours, and it rarely goes beyond 24 hours.
“We place patients that are going to hopefully get out of the hospital a little bit quicker than the traditional patient that’s going to be admitted,” Ross said.
Examples of patients who are ideal for the clinical decision unit would include people who are dehydrated, those diagnosed with simple infections and people with chest pain. The additional time in the hospital allows physicians to further examine them and ensure they’re well enough to go home, he said.
Their care is fast-tracked — quicker to get in, quicker to get treated and quicker to be discharged home compared to traditional units, Ross said.
“Hospital beds have been at a premium, especially during the pandemic. Almost the entire time, the entire hospital was taken,” he said. “We’d have to take them where we could, so sometimes half of our patients in the emergency department were admitted to the hospital.”
Moving them to the clinical decision unit also provides patients with a more comfortable space, Traylor said.
“It’s pretty chaotic sometimes (in the emergency department). We can move them to a quieter area, so that for that extended stay, it’s a little bit quieter and less stressful,” he said.
The first patients entered the clinical decision unit in mid-January. At first, usage was sporadic, but as the emergency department staff has become more familiar with it, usage has gone up in recent weeks, Ross said.
“It was a little bit slow initially as staff got used to it, but now its coming into its own,” he said.
