JUNE 28 - JULY 2, 2020  
30 years of Care Transitions Across the Full Continuum

PP205 – Care Transitions In A Dedicated Observation Unit: A Virtual Reality

PP205 – Care Transitions In A Dedicated Observation Unit: A Virtual Reality

Observation status has been a topic of discussion across the country for the past few years. Because of Medicare’s strict definition of who meets inpatient criteria, the percentage of patients who are placed in observation status continues to rise. Managing costs and resources are paramount to successful discharge planning and coordination of care.

At Texas Health Dallas, there was a 21% rate of observation patients in-house over 48 hours. The Medicare recommended percentage is 4-8%. As a way to decrease this costly endeavor, a virtual observation unit was initiated. The purpose of this project was to reduce observation hours, increase reimbursement by managing the hospital stay, making a decision on an upgrade to inpatient status or discharge between hours 8-26, and improve patient satisfaction for patients in observation status.

The Care Transitions Management (CTM) department played a major role in the creation of the virtual observation unit. The appropriate disciplines were identified and included the Care Transitions Director, Manager and Team Lead, a Clinical Nurse Leader (CNL), Physician Advisor, and the Medical Director for the hospitalist group. A goal of the group began with a deliberate target of managing observation patients regardless of hospital location. The group would focus solely on timely management of care and effective discharge planning. Although there was an initial decrease in observation hours (a drop from 21% to 17%), the virtual team ascertained greater knowledge around the reason for the delays and insight into educational opportunities house-wide.

The virtual observation team morphed into a dedicated observation unit where patients were co-horted on a specific unit. With 2 assigned CTMs leading the push for an efficient transition to the next level of care and treatments that could be continued in an outpatient setting, the average percentage of observation hours dropped to a substantial 7% within a 3-month timeframe.