Short-Stay Units Reduce Extended Wait Times

Most experts agree that a glut of patients waiting for inpatient beds tends to slow throughput in the ED. A recent study conducted by the University of Rochester (NY) Medical Center examined the impact of a hospital’s short-stay inpatient unit on ED waiting times.

At Strong Memorial Hospital, also in Rochester, patients who have a stable internal medical condition and are not expected to be admitted for more than 72 hours are sent to a short-stay unit. The 26-bed unit was created to address the issue of ED overcrowding, with 16 beds designated for ED use. The study showed that the unit dramatically reduced the number of ED "boarders"—patients who were admitted to the hospital but left waiting in the ED for a bed.

"Previously, we were backed up with gridlock," says Jeffrey J. Bazarian, MD, Assistant Professor of Emergency Medicine. "Typically, we’d have eight or 10 people with no place to go because all the beds were filled."

The study looked at the throughput times of the ED’s treat-and-release patients during the four-month interval before the unit opened. The average length of stay during this interval was compared to the average length of stay during the same time period the following year. Chest pain patients had a 24% reduction in length of stay, and asthma patients had a 15% reduction.

Internal medicine patients waiting for hospital beds are now brought to the hospital’s short-stay unit instead of the ED. "It just so happens that the majority of our boarders are internal medicine patients," notes Bazarian. After the unit opened, the average number of ED boarders fell from nine to two each day.

After it was clear there were fewer people waiting in the ED, the next step was to determine how overall waiting times were affected. "We wondered if it made us any quicker in taking care of people who don’t get admitted," says Bazarian. "We did a time study and found that we were able to get certain types of people in and out of the ED much quicker than before."

The same result would probably be achieved by using an observation or holding unit, he says. "When you physically remove people who are waiting around for a bed, you free up the staff to see people coming in anew," says Bazarian. "If you can move those patients to an observation unit, it will have the same effect."

Boarder patients often require substantial time from nurses, physicians, and ancillary personnel. "Rather than rather than moving on to new patients, staff have to take ongoing care of these boarders," says Bazarian. That includes physician evaluations, dispensing routine medications, and frequent nursing assessments.

Part of the impetus for the study came from hospital administrators, who asked for justification for the unit’s existence. "The short-stay unit isn’t cheap to run, and we needed to justify its existence to administrators," Bazarian explains. "We were able to show that although the unit costs some money to run, it’s increasing our billing in the ED and enabling us to see patients faster."

The study revealed a direct relationship to the bottom line. The ED’s professional billing increased by 13% after the unit opened. "We found that the number of patients who get tired of waiting and leave before their workup is complete decreased as well," he says.

The number of patients who left the adult acute section of the ED without being seen dropped by 42%. "That means we’re able to bill for more people than before because if a person gets a little bit of care and leaves, we can’t bill them," Bazarian notes.