SHM Converge Scientific Abstract ePoster Gallery-Virtualizing Observation Care for Improved Throughput

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A multi-hospital system found that observation patients at one hospital had a length of stay about 10 hours longer than elsewhere, but it lacked space and staffing for a dedicated observation unit. To improve throughput, the team created a “virtual” observation model rather than placing patients in one geographic location.<br /><br />The pilot used existing staff to form a multidisciplinary observation team: two hospitalist advanced practice providers, a utilization management nurse, and a physician advisor. The team rounded in person, then held daily virtual multidisciplinary rounds with emergency medicine, pharmacy, radiology, lab, and physical therapy to identify discharge barriers and speed resolution. They also worked to improve admission status accuracy at the emergency department entry point. Patients remained in their usual beds but were managed by this non-geographic observation team.<br /><br />The baseline period was September 2023 and the pilot ran in October 2023. Included were observation and outpatient-in-a-bed admissions; patients under 18, later converted to inpatient status, hospice patients, and those with total admission time under 8 hours were excluded.<br /><br />Results showed a meaningful reduction in length of stay. Mean LOS decreased from 38.6 hours to 28.3 hours (p = 0.01). Median LOS also fell from 33.7 hours to 22.6 hours (p = 0.01), indicating improvement even after accounting for outliers. Variability and maximum LOS were also lower during the pilot.<br /><br />The authors conclude that virtual observation management can reduce LOS and improve care flow without requiring a dedicated physical unit. They suggest this model may be especially useful for hospitals with space or staffing limitations.

Asset Subtitle

Osasumwen Osayimwen

Meta Tag

Author List Alya Ahsan, Christopher Boyle, Julie Wetzel, Mihir Desai, Osasumwen Osayimwen

Category Innovations

Concept Observation Care

Concept Virtual Care Model

Concept Length of Stay

Concept Hospitalist APPs

Concept Multidisciplinary Rounding

Distinguished Non-Finalist

Presenter Organization Endeavor Health

Presenting Author Osasumwen Osayimwen

Track Value in Hospital Medicine

Keywords

virtual observation

length of stay

hospital throughput

multidisciplinary rounds

observation patients

care flow

hospitalist APPs

utilization management

admission status accuracy

non-geographic observation team

Observation Care

Virtual Care Model

Length of Stay

Hospitalist APPs

Multidisciplinary Rounding