MANCHESTER – Most afternoons, workers in the emergency room at Catholic Medical Center start filling beds in the hallway when the department’s 30 rooms are taken.
“I might have sick people out in the waiting room that I physically can’t get in,” CMC’s Kevin Drew said.
So the hospital last week opened a new Clinical Decision Unit, next to the emergency department, to free ER rooms faster without compromising care.
The unit is designed to observe and provide tests to patients who come to the ER and aren’t ready to go home once they are seen by a doctor, but don’t need to be admitted to the hospital. They can include people treated for chest pains, asthma and hypertension.
“With the CDU, this person will get out to the hospital more efficiently, i.e. more quickly, and with the appropriate level of care,” said Alan Flanigan, CDU’s medical director.
“There are people that we send out of the emergency department who probably shouldn’t have gone home, and they went home too early,” Flanigan said during a tour of the new unit.
Sometimes those patients return to the hospital, he said.
CMC, which, handled 36,000 ER visits last year, spent about $3.3 million to build and outfit the 10-bed unit.
The Clinical Decision Unit is “definitely a lot more of a healing environment, if you will, versus the ER, which tends to be very loud 24/7. Doesn’t matter what time of the day you’re in,” said Drew, the unit’s director.
Lu Mulla, vice president of operations clinical and emergency services, said patients can save money going through the CDU rather than being admitted to a regular patient room for more observation and testing.
“The insurance companies also will be paying out less because you’re not in a longer hospital stay,” she said.
Flanigan said it’s a win for the hospital, too.
“Where the hospital benefits is because I open a bed in the emergency room sooner and I don’t occupy that bed in the hospital as long, so now I’m becoming more efficient moving people through the emergency department,” Flanigan said.
In place at Elliot
A similar unit has operated at CMC’s crosstown rival, Elliot Hospital, for more than four years.
“What we found is that most of these patients … leave sort of between 18 and 20 hours out of this unit, better than the 24-plus that we used to see, despite our best efforts,” said Dr. Greg Baxter, Elliot’s chief medical officer and also an emergency room doctor.
Time isn’t the only savings.
“If the patient spends 16 hours rather than 22 hours, they’re only paying for 16 hours, so their cost is going down,” said Steve Loosigian, a hospitalist and president of Elliot’s medical staff.
“They’re paying for that bed hourly, so I think … their cost is definitely decreased,” Loosigian said. “It depends on their payer source; it’s a very complicated question, but overall it’s down.”
Hospitals are finding new ways to meet health care demands, according to Vanessa Stafford, director of communications for the New Hampshire Hospital Association.
“From a statewide perspective, I think hospitals and health systems are implementing a range of strategies to better meet the needs of their communities, including urgent-care centers, free-standing emergency centers and clinical decision units, which allow them to provide their patients the right care, in the right place at the right time,” she said.
According to a 2016 story in AHC Media, which provides medical information and publications for medical professionals, emergency department visits have been increasing nationwide while the availability of inpatient hospital beds have been decreasing.
“Observation medicine is one of the newest and rapidly growing subspecialties in emergency medicine,” the article stated.
Elliot’s Baxter said the CDU isn’t just a matter of saving money.
“If we could do something in a day and it used to take us a day and a half to do, most patients find that 12 hours pretty valuable to them,” he said