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Rapid improvement event leads to new clinical decision unit

24 Nov 2019

Reducing length of stays for observation-status patients

By: Claire O’Brien, MD, chief care coordination officer

In mid-November, clinical leaders and physicians took part in a rapid improvement event to create a new system to reduce time to discharge for observation-status patients. By decreasing length of stay, we can provide the right care for observation patients at reduced cost to the patient and hospital. Last week, we launched the new system — a 14-bed clinical decision unit located on 5NE.

The CDU is different from inpatient units because patients are all SHMG observation patients, and their expected length of stay on the unit is 48 hours or fewer. Before implementing the CDU, the average length of stay for an observation patient was around 55 hours, compared to the national average of 22 hours. While Salem Health was discharging only 52% of observation patients within 48 hours prior to opening the CDU, our goal is to improve this to 70%.

It is important to know that there will still be observation patients in all areas of the hospital and we will need the help of all providers in order to reach the 70% goal. Observation charges are hourly, whereas inpatient charges are by calendar day. To be successful, observation diagnostics and care must be focused, and decisions must be made multiple times per day. This is a culture change for Salem Health, but is the right thing to do for our patients.

Providers on the CDU conduct frequent multidisciplinary rounds on their patients to expedite the decision-making process to either discharge them or convert them to inpatient status as soon as it is appropriate. The patients’ stays are condensed, and the care is focused. As we test this new process for observation patient care, we will look at average length of stay and the percentage of patients discharging or converting to inpatient status within 48 hours to measure success. Readmissions and the number of patients incorrectly placed on the CDU will also be monitored.

Learn more about the CDU from the RIE PowerPoint. You may also view the guidelines for nursing for more detail. Look to future communications to hear about the outcomes of our tests of change and any adjustments we make to the process along the way. If you have any questions, concerns or suggestions, please contact Dr. O’Brien at