Evaluating the Impact of a Second-Level Observation Unit on Patient Outcomes at a Large Academic Health Center with a Coexisting Type I Observation Unit.

Background: Observation units (OUs) are a common healthcare delivery model for health systems across the United States. OUs vary from a type I to type IV based on several factors. Another category of OUs-second-level OUs-does not fit this traditional classification due to a different patient population composition and staffing model. The impact of a second-level OU in the setting of a coexisting type I OU has not been previously evaluated. As such, our study assesses the impact of patient outcomes in a second-level OU with a coexisting type I OU.

Methods: We established a second-level OU comprising 14 beds on a medical-surgical floor. Patients designated as observation status who did not meet the criteria for the type I OU in the emergency department were cohorted on this unit and cared for by a multidisciplinary team that included nurses, case managers, pharmacists, and hospital medicine providers. We compared patient outcomes pre- and postsecond-level OU implementation for all observation status patients admitted to hospital medicine between January 1, 2019 and December 31, 2019.

Results: Patients cohorted on the second-level OU had a shorter length of stay (estimated reduction in 11.7 hours; P < 0.0001) and a lower conversion rate from observation to inpatient status ("admission rate"; 14.5% vs 57.7%; P < 0.0001) in comparison to the nonintervention group; this led to a saving of 506.5 bed-days in comparison to the preimplementation phase.

Conclusions: Implementation of a second-level OU in the setting of a coexisting type I OU led to a reduced length of stay, admission rate, and bed-days saved.