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Maximizing Performance in Emergency Observation Units: Key Metrics and Case Studies

Learn about appropriate KPIs for Emergency Observation Units based on the Dunedin experience, including admission rates, LOS, and performance targets. Explore how these KPIs can improve patient outcomes and unit efficiency. Dive into relevant case studies and international comparisons.

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Maximizing Performance in Emergency Observation Units: Key Metrics and Case Studies

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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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