Observation medicine encompasses the management of selected patients for a timeframe of 6 to 24 hours to assess their need for inpatient admission. This service is best provided in a dedicated observation unit, ideally in the Emergency Department. Relative to traditional admission, studies have shown this alternative to have several beneficial health care outcomes:
The Emory Observation Medicine program is nationally recognized for contributions to the clinical practice of observation medicine, national health care policy, education, and research. Emory’s observation units have been used as benchmark best-practice models in reports from the Institute of Medicine, the Health Care Advisory Board, the American College of Emergency Physicians, and the Center for Medicare and Medicaid Services.
At our Emory affiliated hospitals we provide high quality, accelerated, protocol-driven care to selected emergency department patients. Observation services are provided in a pleasant setting by Emergency Department faculty and staff. Each of our primary hospitals has an observation unit called “Clinical Decision Units” which are nationally recognized benchmarks in this field.
The combined annual 2011 observation unit census of all units was 6,030 patients, with individual CDU volumes as follows: Emory University Hospital (1,639), Emory University Hospital Midtown (2,616), and Grady Memorial Hospital (1,775). The average length of stay in all units is roughly 16 hours with discharge rates of roughly 85%. Commonly observed conditions include patients with chest pain, asthma, congestive heart failure, infections, syncope, and transient ischemic attack. Patient care guidelines and protocols are developed through a combination of evidence based medicine and expert consensus with other respective specialties involved in the care of each condition. This allows care to be standardized to a “best practice” in a way that can be closely monitored.
The medical director of the EUH CDU is Dr. Michael Ross. Emory University Hospital’s 8-bed CDU is adjacent to the emergency department. This unit is staffed 24/7 with an attending emergency physician and associate provider. Commonly observed conditions in this unit include chest pain (41%), dehydration (8%), transient ischemic attack (7%), syncope (6%), abdominal pain (6%), and heart failure (3%). As a tertiary care university hospital, the CDU has a wide array of diagnostic testing to support protocol driven care of these patients – including cardiac stress imaging (nuclear, echo, MRI), echocardiography, coronary CTA, MRI / MRA brain and vascular imaging.
The Medical director of the EUHM CDU is Anwar Osborne.
The Medical Director of the Grady Memorial Hospital CDU is Matt Wheatley.
Leaders in the Emory Observation Medicine section have been instrumental leaders in this area of medicine over the last two decades. Emory leaders have been at the forefront of studying, refining, and promoting optimal models of delivery for emergency and observation services. They have served as advisors in the development of AMA CPT observation codes for physician payment, and CMS APC payment codes for the payment of hospital emergency department and observation services. Dr. Ross served for three years on the CMS APC Advisory Panel, where he chaired the Observation and Visit Subcommittee and was instrumental in policy decisions regarding emergency and observation visits. He has also served as an advisor on observation policy issues for MedPAC, the Lewin Group, and the Health Care Advisory Board.
Dr. Ross is a founding member and the immediate past president of the Society of Chest Pain Centers, an organization committed to quality processes for cardiac patients. Since its formation over ten years ago, over 700 U.S. hospitals have become accredited by SCPC with satellite hospitals in China, the Middle East, and Europe. Under Dr. Ross’ leadership of SCPC, the AHA, and ACC formed a collaborative affiliation to promote a unified definition of “chest pain center” and related issues. Dr. Ross and Dr. Osborne have both traveled to China to assist them in establishing this new model of care for heart attack patients.
Emory University Hospital and Emory University Hospital Midtown are accredited Chest Pain Centers at the highest level standard of being “accredited with PCI”. From the perspective of quality and safety, based on evidence and best practices, this has standardized the care of patients with chest pain, myocardial infarction and acute coronary syndromes. In addition, the process of attaining and maintaining accreditation ties directly into the Emory Healthcare goals of Care Transformation, and has led to a wonderful interdisciplinary collaboration among several departments – Emergency Medicine, Cardiology, Hospital Medicine, Clinical Pathology, and Nuclear Medicine to name a few. This hospital wide integration brings Emory toward a common goal – to prevent untimely death and disability due to acute coronary syndromes.
Dr. Ross serves on the steering committee of ACTION Registry Get-with-the-guidelines, a product of NCDR which is a division of ACC. This is the premier quality data collection tool for hospital based care of patients with acute myocardial infarction (STEMI and NSTEMI). Emory faculty from the Departments of Emergency Medicine (Dr. Ross and Dr. Osborne) and Cardiology (Dr. Rab and Dr. Goyal) also participate in the Atlanta regional Mission Lifeline network, a division of the American Heart Association whose goal is to assure that patients suffering heart attacks anywhere will receive the best care at the most qualified hospitals by integration of pre-hospital care (EMS) with hospitals.