scholarly journals Caring for patients in a hospitalist-run clinical decision unit is associated with decreased length of stay without increasing revisit rates

2014 ◽  
Vol 9 (6) ◽  
pp. 391-395 ◽  
Author(s):  
Kara S. Aplin ◽  
Susan Coutinho McAllister ◽  
Eric Kupersmith ◽  
Jean-Sebastien Rachoin
Keyword(s):  
Length Of Stay ◽  
Clinical Decision ◽  
Decision Unit ◽  
Clinical Decision Unit

12 Predictive Variables Associated With Inappropriate Length of Stay in a 24-hour Clinical Decision Unit

2012 ◽  
Vol 60 (4) ◽  
pp. S5
Author(s):  
A. Loftus ◽  
G. Polak ◽  
L. Rosen ◽  
E. Lawrence ◽  
L. Chacko ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Clinical Decision ◽  
Decision Unit ◽  
Predictive Variables ◽  
Clinical Decision Unit

scholarly journals System outcomes associated with a pediatric emergency department clinical decision unit

CJEM ◽  
2018 ◽  
Vol 21 (2) ◽  
pp. 195-198
Author(s):  
Derin Karacabeyli ◽  
Garth D Meckler ◽  
David K Park ◽  
Quynh Doan
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Clinical Decision ◽  
Pediatric Emergency ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Pediatric Emergency Department ◽  
Short Stay ◽  
Decision Unit ◽  
Clinical Decision Unit

AbstractObjectivesOur objectives were to describe disposition decisions and emergency department return (EDR) rates following a clinical decision unit (CDU) stay; and to determine changes to short stay (<48 hour) hospitalization rates after CDU implementation.MethodsWe conducted a retrospective cohort study of pediatric emergency department (PED) visits with a CDU stay from January 1 to December 31, 2015. Health records data were extracted onto standardized online forms, then used to determine disposition and 7-day EDR rates. Two trained investigators blindly reviewed EDR visits to determine if they were related to the index CDU stay. We compared short stay inpatient admission rates (i.e., hospital length of stay <48 hours) in 2013 and 2015, before and after CDU implementation.ResultsOf 1696 index CDU stays, 1503 (89%) were discharged, and 139 discharged patients (9.2%) had ≥1 clinically-related EDR. Median (IQR) CDU length of stay (LOS) was 4.4 hours (2.7-7.8) and total PED LOS (including CDU) was 7.8 hours (5.4-12.0). Asthma represented 31% of cases. Short stay hospitalization rate decreased from 3.62% in 2013 to 3.23% in 2015 (difference=0.39%; 95% CI=0.15-0.63; p=0.001).ConclusionsMost CDU patients were discharged, but 9% had a clinically-related ED revisit. CDU implementation was associated with a small but significant reduction in short stay hospitalization.

Developing and Evaluating Nurse led Discharge in Acute Medicine

2014 ◽  
Vol 13 (4) ◽  
pp. 159-162
Author(s):  
Vera Nina Gotz ◽  
◽  
Andrew Thompson ◽  
Kevin Jones ◽  
◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Clinical Decision ◽  
Medical Setting ◽  
Acute Medicine ◽  
Decision Unit ◽  
Patient Groups ◽  
Clinical Decision Unit ◽  
Discharge Criteria ◽  
New System

Aims: To develop and evaluate nurse-led discharge criteria for a clinical decision unit in a large NHS Foundation Trust Method: Criteria for nurse led discharge were developed for patients presenting to hospital via the emergency department with chest pain, headache and deliberate self poisoning. Data on length of stay on CDU and readmission were collected for these patient groups during a 2 month period, during which the nurse-led criteria were introduced. Following introduction of the criteria a survey was conducted to evaluate staff opinions of the new system. Results: A trend towards reduced length of stay was noted during the month after introduction of nurse-led discharge (18.26hrs vs 20 hours p=0.582). Our staff survey indicated that the process was popular and has been continued since the study period. Conclusion: Nurse-led discharge using defined criteria is feasible and popular with staff in an acute medical setting.

Abstract 90: Cost-Benefit Comparison of Inpatient versus Clinical Decision Unit Management of TIA

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Deepak Nair ◽  
Michael Gibbons ◽  
Huaping Wang ◽  
Min-Chul Kim ◽  
Judi Beck ◽  
...  
Keyword(s):  
Univariate Analysis ◽  
Clinical Decision ◽  
Cost Of Care ◽  
Adverse Outcomes ◽  
Stroke Recurrence ◽  
Linear Modeling ◽  
Readmission Rates ◽  
Decision Unit ◽  
Management Protocol ◽  
Clinical Decision Unit

Introduction: Because TIA increases the risk of subsequent stroke, rapid TIA management is key to stroke prevention. Controversy remains regarding the appropriate site of care for TIA patients. Recent literature shows high variability in care processes, admission rates, timeliness of interventions, cost of care, and outcomes, regardless of site of care. We developed a rapid TIA management process in our Clinical Decision Unit (CDU) to reduce cost and adverse outcomes. TIA patients that present to our ED are admitted to the CDU, but transfer patients with TIA are admitted to the inpatient unit (IPU). Methods: Retrospectively, we identified TIA cases by ICD coding, and reviewed records from 4/1/2012 to 3/31/2016 for patients in the CDU and in the IPU. We compared length of stay (LOS), cost of care, readmission rates, and TIA/stroke recurrence between the two groups. Statistical analysis included Chi-square and Wilcoxon two-sample test for recurrence and readmission rates, and generalized linear modeling and Poisson analysis for LOS and cost analysis. Results: A total of 731 patients presented for TIA management in the study period; 393 in CDU, and 338 in IPU. There was no statistical difference in age or sex between the two groups. Mean LOS (hours) in CDU vs IPU was 15 vs 108 (p<0.001), respectively. Total cost of care in CDU vs IPU was $3,835 vs $11,904 (p<0.001), respectively. Univariate analysis showed no appreciable difference in recurrent TIA or stroke rates; multivariate analysis of stroke recurrence for CDU (1.0%) vs IPU (3.6%) did show a small difference (p=0.024). When factoring in reduction of stroke recurrence, the final cost savings of the CDU program equaled $8,258 per patient. There was no difference in readmission rates between the two groups. Conclusion: Using a rapid TIA management protocol yielded a significantly lower LOS and cost per patient. This may justify an avoidance of inpatient admission for TIA patients.

The Clinical Decision Unit has a role to play in the management of acute undifferentiated abdominal pain

2012 ◽  
Vol 19 (5) ◽  
pp. 323-328 ◽  
Author(s):  
Jamie G. Cooper ◽  
Dafydd Hammond-Jones ◽  
Eilis O’Neill ◽  
Rafiuddin Patel ◽  
Ross Murphy ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Clinical Decision ◽  
Decision Unit ◽  
Clinical Decision Unit

Symptom-triggered therapy for assessment and management of alcohol withdrawal syndrome in the emergency department short-stay clinical decision unit

2018 ◽  
pp. emermed-2017-206997 ◽  
Author(s):  
Muhammad Fahmi Ismail ◽  
Kieran Doherty ◽  
Paula Bradshaw ◽  
Iomhar O’Sullivan ◽  
Eugene M Cassidy
Keyword(s):  
Emergency Department ◽  
Cumulative Dose ◽  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Alcohol Withdrawal Syndrome ◽  
Clinical Decision ◽  
Short Stay ◽  
Decision Unit ◽  
Clinical Decision Unit ◽  
Oral Diazepam

IntroductionWe previously reported that benzodiazepine detoxification for alcohol withdrawal using symptom-triggered therapy (STT) with oral diazepam reduced length of stay (LOS) and cumulative benzodiazepine dose by comparison with standard fixed-dose regimen. In this study, we aim to describe the feasibility of STT in an emergency department (ED) short-stay clinical decision unit (CDU) setting.MethodsIn this retrospective cohort study, we describe our experience with STT over a full calendar year (2014) in the CDU. A retrospective chart review was conducted and data collection included demographics, clinical details, total cumulative dose of diazepam, receipt of parenteral thiamine, LOS and disposition.Results5% (n=174) of 3222 admissions to CDU required STT. Collapse or seizure (41%, n=71) and alcohol withdrawal (21%, n=37) were the most common reasons recorded for admission to CDU in those who required STT. Median Alcohol Use Disorders Identification Test score was 25 and 112 patients (64%) had at least one Clinical Institute Withdrawal Assessment for Alcohol revised measurement ≥10, triggering a dose of diazepam (20 mg). The median cumulative oral diazepam dose was 20 mg while 24 (15%) patients received a cumulative dose of 100 mg or more. Median time for STT was 12 hours (IQR=12, R=1–48). 3% (n=5) of patients required further general hospital admission and median LOS in CDU, was 22 hours (IQR=20, R=1–168).ConclusionSTT is potentially feasible as a rapid and effective approach to managing alcohol withdrawal syndrome in the ED/CDU short-stay inpatient setting where patient LOS is generally less than 24 hours.

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