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

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