ED manager: 'Hybrid' obs beats alternatives

ED managers have tried several options to offset growing volume, but Bret Nicks, MD, assistant medical director at Wake Forest University Baptist Medical Center in Winston-Salem, NC, says the hybrid observation unit he oversees beats other alternatives.

"You have to create some means of efficient disposition of patients," Nicks says. "If there are no beds in the hospital, you will have boarding and a continuous trickle-down effect."

Some EDs have used other options, such as boarding patients in hallways upstairs. "We've gone through that, but it requires a major change in mantra, plus shuffling of care entities," says Nicks. "Plus, we can't put you up in the hallway if there is no oxygen or appropriate monitoring, and it may violate the fire code."

Some EDs have identified discharge units, which are large rooms for patients who are being discharged, where they can sit on chairs until the process is completed, he says. This unit frees up more beds in the ED.

James B. Bryant, MSN, CEN, CAN-BC, director of emergency and transport services, says, "We had one here at Baptist for six to eight months, but it was not utilized to the degree we hoped." The location was poor, he notes. "It was very remote from the discharging unit and hard to get to," he says. "Also, we did not advertise it well and promote it to docs as an alternative."

Bryant says he hopes to open a new discharge unit next spring in a more favorable location.