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Volumn 31, Issue 10, 2012, Pages 2314-2323

Making greater use of dedicated hospital observation units for many short-stay patients could save $3.1 billion a year

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; COST CONTROL; COST EFFECTIVENESS ANALYSIS; HOSPITAL CARE; HOSPITAL COST; HUMAN; LENGTH OF STAY; MONTE CARLO METHOD; OBSERVATION UNIT; PREVALENCE;

EID: 84871956525     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2011.0926     Document Type: Article
Times cited : (114)

References (42)
  • 1
    • 84871947640 scopus 로고    scopus 로고
    • American College of Emergency Physicians. The national report card on the state of emergency medicine: evaluating the emergency care environment state by state [Internet]. Irving (TX): ACEP [cited 2012 Sep 9]
    • American College of Emergency Physicians. The national report card on the state of emergency medicine: evaluating the emergency care environment state by state [Internet]. Irving (TX): ACEP; 2009 [cited 2012 Sep 9]. Available from: http://www.emreportcard.org/uploadedFiles/ACEP-ReportCard-10-22-08.pdf.pdf
    • (2009)
  • 2
    • 84871970911 scopus 로고    scopus 로고
    • Emergency Medicine Network. 2009 national ED statistics [Internet]. Boston (MA): The Network [last updated 2011 Feb 2; cited 2012 Aug 19]
    • Emergency Medicine Network. 2009 national ED statistics [Internet]. Boston (MA): The Network; 2009 [last updated 2011 Feb 2; cited 2012 Aug 19]. Available from: http://www.emnet-usa.org/nedi/USA.htm
    • (2009)
  • 3
    • 84871974758 scopus 로고    scopus 로고
    • Centers for Disease Control and Prevention. National Ambulatory Medical Care Survey: 2008 emergency department summary tables [Internet]. Atlanta (GA): CDC [accessed 2012 Sep 9]
    • Centers for Disease Control and Prevention. National Ambulatory Medical Care Survey: 2008 emergency department summary tables [Internet]. Atlanta (GA): CDC; 2010 [accessed 2012 Sep 9]. Available from: http://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2008_ed_web_tables.pdf
    • (2010)
  • 4
    • 84871942312 scopus 로고    scopus 로고
    • Centers for Disease Control and Prevention. National Hospital Ambulatory Medical Care Survey factsheet: emergency department [Internet]. Atlanta (GA): CDC [accessed 2012 Sep 9]
    • Centers for Disease Control and Prevention. National Hospital Ambulatory Medical Care Survey factsheet: emergency department [Internet]. Atlanta (GA): CDC; 2011 [accessed 2012 Sep 9]. Available from: http://www.cdc.gov/nchs/data/ahcd/NHAMCS_Factsheet_ED_2009.pdf
    • (2011)
  • 5
    • 33845980852 scopus 로고    scopus 로고
    • Rockville (MD): Agency for Healthcare Policy and Research;; 2006 Feb. (Healthcare Cost and Utilization Project [HCUP] Statistical Briefs, No. 1)
    • Owens P, Elixhauser A. Hospital admissions that began in the emergency department, 2003. Rockville (MD): Agency for Healthcare Policy and Research; 2006 Feb. (Healthcare Cost and Utilization Project [HCUP] Statistical Briefs, No. 1).
    • (2003) Hospital admissions that began in the emergency department
    • Owens, P.1    Elixhauser, A.2
  • 6
    • 33749043001 scopus 로고    scopus 로고
    • Crisis in the emergency department
    • Kellermann AL. Crisis in the emergency department. N Engl J Med. 2006;355(13):1300-3.
    • (2006) N Engl J Med , vol.355 , Issue.13 , pp. 1300-1303
    • Kellermann, A.L.1
  • 7
    • 79956099334 scopus 로고    scopus 로고
    • Factors associated with closures of emergency departments in the United States
    • Hsia RY, Kellermann AL, Shen YC. Factors associated with closures of emergency departments in the United States. JAMA. 2011;305(19): 1978-85.
    • (2011) JAMA , vol.305 , Issue.19 , pp. 1978-1985
    • Hsia, R.Y.1    Kellermann, A.L.2    Shen, Y.C.3
  • 8
    • 84871944527 scopus 로고    scopus 로고
    • Centers for Medicare and Medicaid Services. National Health Expenditure data [Internet]. Baltimore (MD): CMS [modified 2012 Apr 11; cited 2012 Aug 19]
    • Centers for Medicare and Medicaid Services. National Health Expenditure data [Internet]. Baltimore (MD): CMS; 2009 [modified 2012 Apr 11; cited 2012 Aug 19]. Available from: https://www.cms.gov/NationalHealthExpendData/02_NationalHealthAccountsHistorical.asp#TopOfPage
    • (2009)
  • 9
    • 34447579020 scopus 로고    scopus 로고
    • An emergency department diagnostic protocol for patients with transient ischemic attack: a randomized controlled trial
    • Ross MA, Compton S, Medado P, Fitzgerald M, Kilanowski P, O'Neil BJ. An emergency department diagnostic protocol for patients with transient ischemic attack: a randomized controlled trial. Ann Emerg Med. 2007;50(2):109-19.
    • (2007) Ann Emerg Med , vol.50 , Issue.2 , pp. 109-119
    • Ross, M.A.1    Compton, S.2    Medado, P.3    Fitzgerald, M.4    Kilanowski, P.5    O'Neil, B.J.6
  • 10
    • 14844331813 scopus 로고    scopus 로고
    • A comparison of emergency department versus inhospital chest pain observation units
    • Jagminas L, Partridge R. A comparison of emergency department versus inhospital chest pain observation units. Am J Emerg Med. 2005;23(2):111-3.
    • (2005) Am J Emerg Med , vol.23 , Issue.2 , pp. 111-113
    • Jagminas, L.1    Partridge, R.2
  • 11
    • 16944365157 scopus 로고    scopus 로고
    • A comparison between emergency diagnostic and treatment unit and inpatient care in the management of acute asthma
    • McDermott MF, Murphy DG, Zalenski RJ, Rydman RJ, McCarren M, Marder D, et al. A comparison between emergency diagnostic and treatment unit and inpatient care in the management of acute asthma. Arch Intern Med. 1997;157(18): 2055-62.
    • (1997) Arch Intern Med , vol.157 , Issue.18 , pp. 2055-2062
    • McDermott, M.F.1    Murphy, D.G.2    Zalenski, R.J.3    Rydman, R.J.4    McCarren, M.5    Marder, D.6
  • 12
    • 84871950414 scopus 로고    scopus 로고
    • Institute of Medicine. Hospitalbased emergency care: at the breaking point [Internet]. Washington (DC): National Academies Press [cited 2011 Apr 13]
    • Institute of Medicine. Hospitalbased emergency care: at the breaking point [Internet]. Washington (DC): National Academies Press; 2007 [cited 2011 Apr 13]. Available for download from: http://books.nap.edu/openbook.php?record_id=11621
    • (2007)
  • 13
    • 0004256373 scopus 로고
    • Boston (MA): Andover Medical Publishers;
    • Graff LG. Observation medicine. Boston (MA): Andover Medical Publishers; 1993.
    • (1993) Observation medicine
    • Graff, L.G.1
  • 15
    • 84871955068 scopus 로고    scopus 로고
    • To access the Appendix, click on the Appendix link in the box to the right of the article online
    • To access the Appendix, click on the Appendix link in the box to the right of the article online
  • 16
    • 84871946379 scopus 로고    scopus 로고
    • We searched Medline using the following terms: (economics[subheading] OR Cost-Benefit Analysis[MeSH] OR Costs and Cost Analysis[MeSH]) AND (observation status[tiab] OR chest pain evaluation unit[tiab] OR short stay unit[tiab] OR observation unit*[tiab] OR observation center*[tiab] OR chest pain center*[tiab] OR holding room [tiab] OR (emergency department [tiab] AND hospital admissions [tiab]) OR (emergency department based[tiab] AND protocol[tiab]) OR (emergency department[tiab] AND outpatient management [tiab]) OR (EDTU[tiab]))
    • We searched Medline using the following terms: ("economics"[subheading] OR "Cost-Benefit Analysis"[MeSH] OR "Costs and Cost Analysis"[MeSH]) AND ("observation status"[tiab] OR "chest pain evaluation unit"[tiab] OR "short stay unit"[tiab] OR "observation unit*"[tiab] OR "observation center*"[tiab] OR "chest pain center*"[tiab] OR "holding room" [tiab] OR ("emergency department" [tiab] AND "hospital admissions" [tiab]) OR ("emergency department based"[tiab] AND "protocol"[tiab]) OR ("emergency department"[tiab] AND "outpatient management" [tiab]) OR ("EDTU"[tiab]))
  • 17
    • 84871958475 scopus 로고    scopus 로고
    • Bureau of Labor Statistics. Consumer Price Index [Internet]. Washington (DC): BLS [cited 2012 Sep 9]
    • Bureau of Labor Statistics. Consumer Price Index [Internet]. Washington (DC): BLS; 2011 [cited 2012 Sep 9]. Available from: http://www.bls.gov/cpi/data.htm
    • (2011)
  • 18
    • 56849112173 scopus 로고    scopus 로고
    • Actual financial comparison of four strategies to evaluate patients with potential acute coronary syndromes
    • The outlier finding in the article by Chang and colleagues did not compare observation unit care to inpatient care; rather, it compared chest imaging to observation unit care
    • The outlier finding in the article by Chang and colleagues did not compare observation unit care to inpatient care; rather, it compared chest imaging to observation unit care. See Chang AM, Shofer FS, Weiner MG, Synnestvedt MB, Litt HI, Baxt WG, et al. Actual financial comparison of four strategies to evaluate patients with potential acute coronary syndromes. Acad Emerg Med. 2008;15(7):649-55.
    • (2008) Acad Emerg Med , vol.15 , Issue.7 , pp. 649-655
    • See Chang, A.M.1    Shofer, F.S.2    Weiner, M.G.3    Synnestvedt, M.B.4    Litt, H.I.5    Baxt, W.G.6
  • 19
    • 0022638614 scopus 로고
    • Outpatient oral rehydration in the United States
    • The Listernick study was conducted in 1986, and the high savings amount was probably exaggerated by high rates of medical inflation over the subsequent decades
    • The Listernick study was conducted in 1986, and the high savings amount was probably exaggerated by high rates of medical inflation over the subsequent decades. See Listernick R, Zieserl E, Davis AT. Outpatient oral rehydration in the United States. Am J Dis Child. 1986;140(3):211-5.
    • (1986) Am J Dis Child , vol.140 , Issue.3 , pp. 211-215
    • See Listernick, R.1    Zieserl, E.2    Davis, A.T.3
  • 21
    • 35448967849 scopus 로고    scopus 로고
    • The potential effect of iron defortification on iron-deficiency anaemia in the US population
    • Tao M, Pelletier DL, Miller DD. The potential effect of iron defortification on iron-deficiency anaemia in the US population. Public Health Nutr. 2007;10(11):1266-73.
    • (2007) Public Health Nutr , vol.10 , Issue.11 , pp. 1266-1273
    • Tao, M.1    Pelletier, D.L.2    Miller, D.D.3
  • 22
    • 70350687996 scopus 로고    scopus 로고
    • Seasonal transmission potential and activity peaks of the new influenza A (H1N1): a Monte Carlo likelihood analysis based on human mobility
    • Balcan D, Hu H, Goncalves B, Bajardi P, Poletto C, Ramasco JJ, et al. Seasonal transmission potential and activity peaks of the new influenza A (H1N1): a Monte Carlo likelihood analysis based on human mobility. BMC Med. 2009;7(45): 1-12.
    • (2009) BMC Med , vol.7 , Issue.45 , pp. 1-12
    • Balcan, D.1    Hu, H.2    Goncalves, B.3    Bajardi, P.4    Poletto, C.5    Ramasco, J.J.6
  • 23
    • 46149084920 scopus 로고    scopus 로고
    • A feasibility study to calculate unshielded fetal doses to pregnant patients in 6-MV photon treatments using Monte Carlo methods and anatomically realistic phantoms
    • Bednarz B, Xu XG. A feasibility study to calculate unshielded fetal doses to pregnant patients in 6-MV photon treatments using Monte Carlo methods and anatomically realistic phantoms. Med Phys. 2008;35(7): 3054-62.
    • (2008) Med Phys , vol.35 , Issue.7 , pp. 3054-3062
    • Bednarz, B.1    Xu, X.G.2
  • 24
    • 0030710223 scopus 로고    scopus 로고
    • Costs of an emergency department-based accelerated diagnostic protocol vs hospitalization in patients with chest pain: a randomized controlled trial
    • Roberts RR, Zalenski RJ, Mensah EK, Rydman RJ, Ciavarella G, Gussow L, et al. Costs of an emergency department-based accelerated diagnostic protocol vs hospitalization in patients with chest pain: a randomized controlled trial. JAMA. 1997;278(20):1670-6.
    • (1997) JAMA , vol.278 , Issue.20 , pp. 1670-1676
    • Roberts, R.R.1    Zalenski, R.J.2    Mensah, E.K.3    Rydman, R.J.4    Ciavarella, G.5    Gussow, L.6
  • 25
    • 0344737779 scopus 로고    scopus 로고
    • A national survey of observation units in the United States
    • Mace SE, Graff L, Mikhail M, Ross M. A national survey of observation units in the United States. Am J Emerg Med. 2003;21(7):529-33.
    • (2003) Am J Emerg Med , vol.21 , Issue.7 , pp. 529-533
    • Mace, S.E.1    Graff, L.2    Mikhail, M.3    Ross, M.4
  • 27
    • 79959317539 scopus 로고    scopus 로고
    • Critical pathways for postemergency outpatient diagnosis and treatment: tools to improve the value of emergency care
    • Schuur JD, Baugh CW, Hess EP, Hilton JA, Pines JM, Asplin BR. Critical pathways for postemergency outpatient diagnosis and treatment: tools to improve the value of emergency care. Acad Emerg Med. 2011;18(6):e52-63.
    • (2011) Acad Emerg Med , vol.18 , Issue.6
    • Schuur, J.D.1    Baugh, C.W.2    Hess, E.P.3    Hilton, J.A.4    Pines, J.M.5    Asplin, B.R.6
  • 28
    • 80052703871 scopus 로고    scopus 로고
    • National study of emergency department observation services
    • Wiler JL, Ross MA, Ginde AA. National study of emergency department observation services. Acad Emerg Med. 2011;18(9):959-65.
    • (2011) Acad Emerg Med , vol.18 , Issue.9 , pp. 959-965
    • Wiler, J.L.1    Ross, M.A.2    Ginde, A.A.3
  • 30
    • 84872003988 scopus 로고    scopus 로고
    • Centers for Medicare and Medicaid Services. The Medicare Recovery Audit Contractor (RAC) program: an evaluation of the 3-year demonstration. Baltimore (MD): CMS Jun;
    • Centers for Medicare and Medicaid Services. The Medicare Recovery Audit Contractor (RAC) program: an evaluation of the 3-year demonstration. Baltimore (MD): CMS; 2008 Jun.
    • (2008)
  • 32
    • 80052849437 scopus 로고    scopus 로고
    • Gibson Chambers JJ, Baugh CW, Bohan JS, Schuur JD. Use of observation care in US emergency departments
    • Venkatesh AK, Geisler BP, Gibson Chambers JJ, Baugh CW, Bohan JS, Schuur JD. Use of observation care in US emergency departments, 2001 to 2008. PLoS One. 2011;6(9): e24326.
    • (2011) 2001 to 2008. PLoS One. , vol.6 , Issue.9
    • Venkatesh, A.K.1    Geisler, B.P.2
  • 33
    • 84871991464 scopus 로고    scopus 로고
    • FierceHealthcare. Letter from Marilyn Tavenner, Centers for Medicare and Medicaid Services acting administrator and chief operating officer, to Richard Umbdenstock, American Hospital Association president and CEO, July 7 [Internet]. Washington (DC): FierceHealthcare. 2010 Jul 13 [cited 2012 Sep 9]
    • FierceHealthcare. Letter from Marilyn Tavenner, Centers for Medicare and Medicaid Services acting administrator and chief operating officer, to Richard Umbdenstock, American Hospital Association president and CEO, July 7, 2010 [Internet]. Washington (DC): FierceHealthcare. 2010 Jul 13 [cited 2012 Sep 9]. Available from: http://www.fiercehealthcare.com/press-releases/centers-medicaremedicaid-services-letter-americanhospital-association-extended-obse
    • (2010)
  • 34
    • 84872002622 scopus 로고    scopus 로고
    • Advisory Board Company. Patients sue over hospital "observation status." Daily Briefing [serial on the Internet]. 2011 Nov 4 [cited 2012 Sep 9]
    • Advisory Board Company. Patients sue over hospital "observation status." Daily Briefing [serial on the Internet]. 2011 Nov 4 [cited 2012 Sep 9]. Available from: http://www.advisory.com/Daily-Briefing/2011/11/04/Patients-sue-HHS-overobservation-status-rules
  • 35
    • 84862866313 scopus 로고    scopus 로고
    • Sharp rise in Medicare enrollees being held in hospitals for observation raises concerns about causes and consequences
    • Feng Z, Wright B, Mor V. Sharp rise in Medicare enrollees being held in hospitals for observation raises concerns about causes and consequences. Health Aff (Millwood). 2012;31(6):1251-59.
    • (2012) Health Aff (Millwood) , vol.31 , Issue.6 , pp. 1251-1259
    • Feng, Z.1    Wright, B.2    Mor, V.3
  • 36
    • 84871942605 scopus 로고    scopus 로고
    • American Hospital Association. Hospital facts to know [Internet]. Chicago (IL): AHA Mar[cited 2012 Sep 9]
    • American Hospital Association. Hospital facts to know [Internet]. Chicago (IL): AHA; 2008 Mar [cited 2012 Sep 9]. Available from: http://www.aha.org/content/00-10/08-issue-facts-to-know-.pdf
    • (2008)
  • 37
    • 84855393062 scopus 로고    scopus 로고
    • The savings illusion-why clinical quality improvement fails to deliver bottom-line results
    • Rauh SS, Wadsworth EB, Weeks WB, Weinstein JN. The savings illusion- why clinical quality improvement fails to deliver bottom-line results. N Engl J Med. 2011;365(26):e48.
    • (2011) N Engl J Med , vol.365 , Issue.26
    • Rauh, S.S.1    Wadsworth, E.B.2    Weeks, W.B.3    Weinstein, J.N.4
  • 38
    • 84871988422 scopus 로고    scopus 로고
    • Nursing costs are traditionally accounted for separately from professional (physician) costs in hospital accounting. Typically these costs are included with hospital costs, which are allocated as indirect costs
    • Nursing costs are traditionally accounted for separately from professional (physician) costs in hospital accounting. Typically these costs are included with hospital costs, which are allocated as indirect costs.
  • 40
    • 0035140192 scopus 로고    scopus 로고
    • Economic issues in observation unit medicine
    • Roberts R, Graff LG. Economic issues in observation unit medicine. Emerg Med Clin North Am. 2001; 19(1):19-33.
    • (2001) Emerg Med Clin North Am , vol.19 , Issue.1 , pp. 19-33
    • Roberts, R.1    Graff, L.G.2
  • 42
    • 78650905131 scopus 로고    scopus 로고
    • Emergency department observation units: a clinical and financial benefit for hospitals
    • Baugh CW, Venkatesh AK, Bohan JS. Emergency department observation units: a clinical and financial benefit for hospitals. Health Care Manage Rev. 2011;36(1):28-37.
    • (2011) Health Care Manage Rev , vol.36 , Issue.1 , pp. 28-37
    • Baugh, C.W.1    Venkatesh, A.K.2    Bohan, J.S.3


* 이 정보는 Elsevier사의 SCOPUS DB에서 KISTI가 분석하여 추출한 것입니다.