p.4 - GO
To Admit or
Not to Admit
With emergency departments across the country seeing record numbers of patients, creative approaches are buying valuable evaluation time.

When someone would come into the Emergency Department at Howard County General Hospital and say "chest pain," the word that followed was usually admission-as in admission to the hospital's intensive care or intermediate care unit. But many such patients, says Colleen Thornton, nurse manager for intermediate care, suffer symptoms that mimic cardiac chest pain, including muscular and respiratory problems. They need to be monitored, and not necessarily admitted to an expensive ICU.

"Not only were these admissions adding unnecessary costs to health care, but they were also taking up valuable intensive care space in the hospital," says Thornton, noting that fewer than half of the chest-pain admissions through the ED were actual cardiac-pain patients.

"It was set up and lo and behold, we got the length of stay down to 12 hours."

Howard County General Hospital's chest pain unit, says nurse manager Colleen Thornton, has significantly reduced unnecessary and expensive hospital admissions. The same is true at Hopkins Bayview, where a similar unit set up four years ago as part of the medical center's extended-stay unit means patients can be admitted without taking up scarce acute-care inpatient beds. "One of the biggest advantages," says Bayview ED Director Edward Bessman, "is that it allows us to identify individuals who you might not think have acute coronary syndrome, but in fact do."

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