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