Health Team

Duke's observation unit saves time and lives

Posted January 22, 2009 5:07 p.m. EST
Updated January 25, 2009 4:37 p.m. EST

— Overcrowded emergency rooms often lead to overcrowded in-patient rooms. That leads to higher costs for both the hospital and patients. Duke University Hospital has a solution for both issues.

A few days ago, Ron Reece says a small red spot appeared on his left ankle and he felt sick.

“Got these flu-like symptoms, at least I thought it was the flu,” Reece said.

The spot spread into a massive skin infection that led him to the Duke Emergency Department. Rather than being admitted to a hospital room, Reece, 70, was treated in an observation room.

Dr. Abhinav Chandra, with Duke Emergency Medicine, says the 7-year-old observation unit is a model for several hospitals across the state.

“It allows us to take care of those folks that need more than four hours of emergency care, but perhaps not a full day's worth of care,” Chandra said.

For Reece, it allows time for doctors to do more extensive tests to discover the nature of his skin infection.

For patients who come in with chest pain, one out of six of them have heart problems. In the past, many people might have been sent home, only to have a heart attack.

“With a chest pain unit, we can watch these folks perform a stress test and if everything is OK, we can get all of this done in 18 hours,” Chandr said.

An around-the-clock staff of doctors, physician assistants and nurses makes getting a diagnosis more efficient – leading to faster discharge.

Chandra says several studies indicate if observation units were a uniform program nationwide, it would save an estimated $500 million a year. For Congestive Heart Failure patients, the savings would be $5 billion a year.

Compared to a regular hospital room, patients in observation rooms pay less.

“They can save up to $2,000 in that visit,” Chandr said.

Reece says he can appreciate the savings and the expert care he has received.

“Let's put it this way, I hate to be here, but I'm really getting the service (I need),” Reece said.

The Duke observation unit depends heavily on physician assistants that allow primary doctors to spend more time with critically-ill patients.