Helen C. D'Souza
Daniel J. Miesle
Continuum Solutions Consulting
Indianapolis, Indiana

In recent years, managed care plans have begun to reshape care delivery in emergency departments. Significant pressure to treat and release patients has become routine. Through consultations with a number of hospitals, it became apparent that the future necessity for Observation Care Units (OCUs) is certain. It was also clear that there is limited understanding of the forces that govern observation care and that even a definition of what constitutes an OCU is not universally accepted.

We undertook a national study on OCUs to learn more about this trend and develop a planning model that can be utilized by healthcare facility planners. Utilizing a mail survey, we realized 109 responses (29 percent response rate) from across the country.

Contemporary OCUs closely associated with emergency care are units in which observation requires active, on-going evaluation, treatment, and clinical outcome analysis rather than the passive observation in the traditional holding unit. This model seeks to reduce the time for diagnosis and treatment, thereby improving quality of care and cost effectiveness.

Major findings included strong agreement on specifics of operational and design issues focusing on maintaining optimal efficiency of the unit. Managed care penetration in a given market place appears to enhance the degree to which hospitals are likely to establish such units. Increased size of the institution also favors the implementation of OCUs. This trend is likely to continue and hospitals will need to remodel or dramatically change facilities to accommodate this new model of care delivery.

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