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Emergency Observation Units: What are appropriate KPI’s?

Emergency Observation Units: What are appropriate KPI’s?. Justin Moore MHsc endorsed Nursing (Clinical) Charge Nurse Manager Dunedin Emergency Department Southern District Health Board. Emergency Observation Units: The Dunedin experience. ED Obs Unit opened August 2012

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Emergency Observation Units: What are appropriate KPI’s?

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  1. Emergency Observation Units: What are appropriate KPI’s? Justin Moore MHsc endorsed Nursing (Clinical) Charge Nurse Manager Dunedin Emergency Department Southern District Health Board

  2. Emergency Observation Units: The Dunedin experience • ED Obs Unit opened August 2012 • 10 bed unit servicing 21 bed Emergency Dept • 39,000 presentations, poor 6 Hour Target performers • Strict admission criteria with senior RN and Dr ability to veto • Clock to only stop for true ED admissions not inpt expects or referrals (exception being those referred after being admitted under ED)

  3. Emergency Observation Units: The Dunedin experience - KPIs • KPIs broad • LOS – less than 23hrs • LOS in ED Obs Units varies both nationally and internationally 12-72hrs • Percentage admitted to inpt facilities • Literature supports admission rates of 15 to 20 % • Less than 10% admission thought to demonstrate that Obs Unit admission criteria is too strict • More than 20% admission thought to demonstrate that Obs Unit admission criteria is too loose • Percentage of ED Obs Unit Patients compared to Emergency Presentations • 6 Hour Target performance

  4. ED Obs Units LOS – 21 studies (Integrative review 2002-2012)

  5. Admission Rates • an acceptable admission rate to hospital of 11% (Madsen et al., 2009) • Of the geriatric cohort, 17% were admitted to an inpatient facility compared to 10.7% of those under the age of 65 years (Madsen et al., 2008). • The admission rate was within acceptable guidelines of up to 15%... (Sherwood et al. (2011)

  6. Emergency Observation Units: The Dunedin experience – KPIs and results • KPIs broad • LOS – less than 23hrs • Goal 90% (Original business case 2011) 2013 - 100% • Percentage admitted to inpt facilities • Goal up to 20% (Original business case 2011) 2013 9.23% - 492 of 5328 patients (? Need to loosen our criteria) • Percentage of ED Obs pts to ED Presentations • 2013 12.13% - 5,328 of 43,910 presentation • 6 Hour Target performance • Pre Obs Unit 2011 77.86% • Post Obs Unit 2013 91.45%

  7. KPI’s Queensland Health ED SSUs • Key performance indicators under the National Emergency Access Target • Percentage of ED presentations admitted to the Short Stay Unit • Length of stay in the ED prior to admission to the Short Stay Unit • Short Stay Unit length of stay • Accuracy of assessment for detecting suitability for admission to the Short Stay Unit (e.g. failed Short Stay Unit admissions) • Final disposition/departure destination • Representation to ED within 24 hours or 48 hours of departure from Short Stay Unit http://www.health.qld.gov.au/caru/improving-services/sdm-short-stay-unit.asp

  8. American College of Emergency Physicians – ED Obs KPIs (2011) www.acep.org/content.aspx?id=82396

  9. Questions ?

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