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CDU: Clinical Decision Unit - University of Pittsburgh ... 5-CDU... · PDF fileCDU: Success Stories 9 . A CQI Process –Learning curve –Practice curve –Role of CM, RN, & MD –Already

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March 4, 2013

CDU: Clinical Decision Unit

January 2013 - M O N T H January 2013 - F Y T D

Actual Budget Pr Yr Bud Var Actual Budget Pr Yr Bud Var

Acute Admits 1,575 1,474 1,489 101 10,653 10,645 10,752 8

Obs Admits 597 477 496 120 4,256 3,224 3,110 1,032

Obs ALOS 1.41 1.82 1.82

(0.41) 1.39 1.59 1.59 (0.20)

Total Acute Admits + Obs 2,172 1,951 1,985 221 14,909 13,869 13,862 1,040

Obs % of total 27% 24% 25% 29% 23% 22%

IP Admissions flat YTD

> 1,000 OBs admissions YTD 2012 v 2013

7% increase in OBs admissions in just 1 year

THE OBSERVATION SURGE

2

Problem:

25-40% of patients in a bed at

MN are in Observation status

Estimate approximately $5K in

payment difference

OBs pts scattered across the

house

Staff, providers, and hospital

treat OBs and IP similarly

Little difference, little urgency

3 Main open and closes in

response to volume/need

CDU

3

A SOLUTION CDU

Aggregate OBs patients on

3 Main

Keep open 24/7

Focus staff on rapid

treatment and decisions

Dedicated CM & staff

Aligned messaging to

patients

Bills audited prior to drop

CDU

4

Inclusion Diagnoses:

Low Risk CP

Abdominal pain

Asthma

Atrial Arrhythmias

Allergic Rx

Back Pain

Dehydration

Syncope

TIA

Low Risk CHF

CDU: The Patients

5

Inclusion Criteria:

OBs status

Tele/Remote Tele/RNF

Ambulate independently

Perform ADLs independently

Exclusion Criteria:

Isolation (beyond contact)

Titration of meds

O2 > 6L/M or O2 Sat < 93%

BH or addiction issues

Nursing home or placement issues

CDU: The Patients

6

Effective Monday March 4:

13 beds (can double up)

Tele/Remote Tele

availability

Currently 1 bed/room

Short stay ADM

assessment

2 RNs/1 PCT 7A-11P

2 RNs 11P

Tracking board

Order sets

CDU: The Organzaiton

7

Collaborative Approach

Over 10 meetings with ED, Hospitalists, &

Cardiologists

Nursing Supervisors, Nurse Leaders, CM

etc

The Drivers:

1. ED Physicians

Identify patients by diagnoses,

inclusion, and exclusion criteria

Work with CM to optimize

criteria/status

Enters floor

2. Hospitalists

Further identify patients

May change room/unit

Manage care on 90% of patients

3. Cardiologists

Manage their own patients

CDU: The Physician Drivers

8

Mr L

53 YO Male

Recent onset CP, heart racing

Hx CAD

ED at 08:54 AM

CDU at 11:39 AM

3 Troponin Levels negative

Stress negative at 14:00

Patient asymptomatic

Tummy ache

DC at 16:20

Appointment with PCP 1 week

Ms W

45 YO Female

Recent onset Resp Distress

Hx COPD and HIV

ED at 06:01 nebs, roids, fluids

CDU at 10:11

Potassium, antibx, roids

Observed resp status

Monitored O2 requirements

Needed HH and 02 Tank

DC at 18:25

HH appointment following day

CDU: Success Stories

9

A CQI Process

Learning curve

Practice curve

Role of CM, RN, & MD

Already shifted to boxed lunches

Improve DC times

Optimize status

Better manage hospital resources

Place IPs in IP beds

CDU

10

THE VISION

26 patients in 13

rooms

How many

beds/rooms?

Home meds

Meals

Order Sets

Inclusion/Exclusion

Criteria

CDU

11

CDU

12

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