ED Obs Annual Report 2021

ED OBSEVATION UNIT ANNUAL REPORT 2021

2021 PAGE 1 INTRODUCTION The Brigham and Women's Emergency Department Observation Unit officially opened on May 1st, 1996. This report covers the 25th year of dedicated ED observation care within our department and covers the period of January 1st through December 31st, 2021. MISSION AND VISION The Brigham and Women's Emergency Department Observation Unit (EDOU) fills a needed role by providing a setting of care for patients who do not meet inpatient admission requirements but rather need additional diagnostic workup or therapies beyond the scope of a typical emergency department visit. The pillars of proper patient selection, evidence-based interventions, and safe discharge planning lay the foundation for the successful protocol driven care provided in our unit. As we continue to navigate a medical landscape complicated by the ongoing SARS COVID-19 pandemic and periods of unprecedented capacity challenges, our observation unit will continue to serve as a viable option to shift eligible patients out of inpatient beds, avoid unnecessary admission, generate department revenue all while still providing patient-centered care. in line with the Brigham Way. BWH ED OBSERVATION UNIT ANNUAL REPORT 2021

2021 PAGE 2 David Meguerdichian, MD Audrey Reust, PA-C Director of Observation Medicine Associate Director of Observation Medicine NEW LEADERSHIP TEAM In 2021, Dr. David Meguerdichian and Audrey Reust, PA-C, were appointed to lead the Brigham and Women's Hospital Emergency Department Observation Unit. From the outset, this pair identified patient safety and operational efficiency as key focal points for their inaugural year of leadership. Aside from many of the initiatives highlighted elsewhere in this report, Dr. Meguerdichian and PA Reust worked closely with the ED Operations team to consolidate and organize observation care into two pods, Fairfield and Dartmouth, while also clarifying pass-off and responding clinician roles for the attending and resident physician groups. This effort helped streamline care, bolstered patient safety, and decreased staff confusion around assignments within EDOU. ED OBS OPERATIONS TEAM The ED Obs Operations Team is a multidisciplinary group of emergency department leaders that meets monthly to review EDOU patient data and address logistical challenges arising from the clinical unit. The ED Obs Operations team includes: David Meguerdichian, MD Audrey Reust, PA-C Anna Meyer, RN Jessica Britnell, PA-C Christie Lucente, PA-C Tom Murray, RN Paul Chen, MD Gabrielle Cayo, RN Jonny McCabe, RN BWH ED OBSERVATION UNIT ANNUAL REPORT 2021

2021 PAGE 3 EDOU VOLUME EDOU overall Volume EDOU volume remained consistent on a monthly basis throughout 2021. After recovering from the COVID pause of 2020, monthly volume ranged from a low of 464 to a high of 558 patients. EDOU Non-Behavioral Health Volume Non-behavioral health patients, those placed in observation for medical or surgical protocols, accounted for greater than 2/3 of the volume of observation patients cared for in 2021. The monthly census remained consistent for the year ranging from a monthly low of 381 to a high of 456 patients. EDOU Behavioral Health Volume Patients placed in the observation unit for behavioral health care, often awaiting psychiatric bed placement, accounted for 1/3 or less of the total EDOU volume for 2021. The monthly census ranged from a low of 79 to a high of 120. BWH ED OBSERVATION UNIT ANNUAL REPORT 2021

2021 PAGE 4 EDOU LENGTH OF STAY EDOU LOS (Median) In line with EDOU standards, median length of stay numbers for EDOU patients fell within the accepted 24-48 hour window. In fact, this value ranged from 15 to 18 hours, in line with care that spans one midnight in the observation unit. EDOU LOS (AVERAGE) The average length of stay values register slightly higher accounting for a subset of patients in the overall census whose observation care reached or at times, exceeded the 48 hour mark. BWH ED OBSERVATION UNIT ANNUAL REPORT 2021

2021 PAGE 5 HIGHLIGHTS AND SUCCESS Under the new leadership of David Meguerdichian, MD, Director of Observation Medicine, and Audrey Reust, PA-C, Associate Director of Observation Medicine, several key patient- centered initiative were developed and deployed in 2021 to address patient safety, operations, and challenges posed by COVID-19 and hospital crowding. COVID 19 OBS .edobsstickynote PROTOCOL OBS STICKY NOTE TEMPLATE OBS BEST ED OBS HOME PRACTICES GUIDE HOSPITAL COLLABORATION BWH ED OBSERVATION UNIT ANNUAL REPORT 2021

2021 PAGE 6 OBSERVATION UNIT INITIATIVES COVID 19 EDOU PROTOCOL This novel protocol was developed in conjunction with the MGH Emergency Department Observation Medicine leadership with a goal of providing a safe care option for those COVID-19 patients too ill to be discharged but whose hemodynamics or clinical picture did not warrant admission. ED OBS STICKY NOTE TEMPLATE This Epic templated dot phrase was created to provide a standard, consistent means of displaying important information that can be rapidly accessed regarding our obs patients. These notes are now a vital part of the way we communicate during pass off and provide a centralized location to communicate important details such as DVT prophylaxis status, family/facility contact information, and a flag to notify providers if a patient has health related social needs. ED OBS BEST PRACTICES GUIDE This resource, available on EM Web as well as in hard copy in every ED unit, was created to help streamline and improve the workflow and care of patients in EDOU. The document spans important information from key admission practices to vital contact details for important testing resources. ED OBS HOME HOSPITAL COLLABORATION This collaborative effort was created with the goal of increasing capacity both within the emergency department and the hospital as a whole. Through targeted rounds with the Home Hospital Group, this working relationship helped identify and transition patients out of EDOU and onto the Home Hospital service for continuation of the care. This effort helps open up obs beds, subsequently freeing up new acute ED beds, and avoids the use of scarce inpatient beds in a time of extreme hospital census. BWH ED OBSERVATION UNIT ANNUAL REPORT 2021

2021 PAGE 7 EDOU FINANCES Total charges for BWH observation visits for FY21 were $5,303,183. Looking at actual payments instead of charges, the sum of payments for FY’12 amounted to $1,581,909. Analysis of charges and payments per visit are displayed below (see Table). Observation visits have higher returns overall but lower returns if analyzed from a revenue/hour perspective. Even so, there are indirect savings as less active care and personnel are needed to provide observation services. Further value comes from redirecting observation level patients away from inpatient beds, ensuring receipt of proper payment for both levels of patients and impacting ED volume, available beds, and ultimately ED revenue through decreased number of boarders and fewer walkouts. Charge/Visit PYMT/Visit FY21 EM Visit Codes $625.21 $218.90 (excluding procedures) FY21 EM Visit Codes with $672.59 $232.68 Procedures FY21 Observation Visit Codes $711.41 $220.27 (excluding procedures) FY21 EM Observation Codes $1396.18 $410.87 with Procedures 2022 EDOU GOALS Transition EDOU into the Berkley Pod Support the launch of the Behavioral Health Observation Unit Investigate and develop new EDOU Protocols (eg: Oncology Pain, Protocol Frailty Protocol) Collaborate with pharmacy around medication reconciliation best practices Support the expansion of the MGB Virtual Observation Unit Work with ED Finance team and LogixHealth to optimize Obs payments BWH ED OBSERVATION UNIT ANNUAL REPORT 2021