Emergency Observation Units: What are appropriate KPI’s?
Justin Moore MHsc endorsed Nursing (Clinical)Charge Nurse Manager
Dunedin Emergency DepartmentSouthern District Health Board
Emergency Observation Units: The Dunedin experienceED 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)
Emergency Observation Units: The Dunedin experience - KPIs
KPIs broadLOS – less than 23hrs
LOS in ED Obs Units varies both nationally and internationally 12-72hrsPercentage 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 strictMore than 20% admission thought to demonstrate that Obs Unit admission
criteria is too loosePercentage of ED Obs Unit Patients compared to Emergency Presentations6 Hour Target performance
ED Obs Units LOS – 21 studies (Integrative review 2002-2012)Authors Year Length of stay
Arendts, et al. 2006 24 hr maximum
Chan, Arendts& Stevens 2008 Expected to be < 24 hrs
Crenshaw, et al. 2006 Based on a LOS of < 48 hours.
Decker, et al. 2008 Atrial Fibrillation specific study that had an 8 hrs management protocol
Diercks, et al. 2006 < 24 hrs
Gonnah, et al. 2008 < 48 hrs
Holly, et al. 2011 < 24 hrs
Iannone&Lenzi 2009 < 24 hrs
Juan, et al. 2006 72 hours maximum
Madsen, Bledsoe &Bossart 2009 Not stated but average LOS of study group <13 hrs
Menditto, et al. 2012 24 to 48 hrs
Miro, et al. 2010 < 24 hrs
Nahab, et al. 2011 Averaging < 25 hrs for TIA patients
Ross, et al. 2003 < 24 hrs
Salazar, et al. -identified from Juan et al
2006
2007 72 hrs maximum LOS
Sherwood, et al. 2011 < 23 hrs
Storrow, et al. 2008 Mean LOS of 25 hrs
Sztajnkrycer, Mell&Melin 2008 < 23 hrs
Venkatesh, et al. 2011 < 72 hrs
Wiler, Ross &Ginde 2011 < 48 hrs
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)
Emergency Observation Units: The Dunedin experience – KPIs and results
KPIs broadLOS – 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 Presentations2013 12.13% - 5,328 of 43,910 presentation
6 Hour Target performancePre Obs Unit 2011 77.86%Post Obs Unit 2013 91.45%
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
American College of Emergency Physicians – ED Obs KPIs (2011)
www.acep.org/content.aspx?id=82396
Questions
?