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Dome - Room for the Right Decision

Dome July/August 2014

Room for the Right Decision

Date: July 8, 2014

The option to monitor emergency patients at Suburban Hospital improves care and reduces costs.


Clinical decision units help to manage care in the most effective and safe way, says Matthew Leonard, director of Suburban Hospital’s critical decision unit.
Clinical decision units help to manage care in the most effective and safe way, says Matthew Leonard, director of Suburban Hospital’s critical decision unit.

To provide the most appropriate level of care at the right time and in the right setting, many hospitals, including Suburban Hospital, are establishing clinical decision units.

“For us, it means managing care in the most effective and safe way for the more than 40,000 patients who come through our Emergency Department doors each year,” says Matthew Leonard, director of Suburban Hospital’s clinical decision unit.  

A bridge between home and the hospital

The hospital’s 16-bed unit creates an option other than discharge or hospital admission for Emergency Department patients, who may benefit from additional monitoring, evaluation or treatment. It expands caregivers’ ability to evaluate patients thoughtfully and efficiently, while also reducing initial missed diagnoses. Since the pilot program’s launch in 2012, Suburban Hospital has seen a decrease in missed cardiac events, lengths of patient stays, nursing hours and ambulance diversions when the Emergency Department is at capacity.

Clinical decision units provide many benefits, Leonard says, “including improved patient and staff satisfaction, improved quality of patient care, reduced health care costs, shorter lengths of patient stays and decreased readmission rates.”

Working collaboratively, the multidisciplinary clinical decision unit care team consists of a physician, nurse practitioner, case manager, social worker, pharmacist and nurse. The team constantly reevaluates patients to determine if they need to be hospitalized or if they can be safely discharged. 

Common symptoms and conditions for patients placed in these units include chest pain, abdominal pain, congestive heart failure, syncope (fainting), asthma, chronic obstructive pulmonary disease, gastroenteritis and transient ischemic attack (mini-stroke). Patients are admitted to the hospital when their condition does not improve or worsens. To guarantee proper follow-up care, the clinical decision unit team is in constant contact with primary care physicians whose patients receive treatment in the unit.

Clinical decision units have played a role in emergency medicine since the 1990s, according to Leonard. Their numbers have multiplied significantly over the past few years as regulations from Medicare have made it harder to admit patients to the hospital. A study published last year in Health Affairs suggests such protocol-driven observation units have the potential to save billions of dollars annually.

 —Stephanie Shapiro and Ronna Borenstein

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