Expanding Our Services: New Observation Units

Patient flow is an ongoing issue in the Loma Linda University Health Emergency Departments (ED). In seeking to address a part of this issue, we identified a sufficient amount of observation patients on inpatient units to fill, at a minimum, half a unit. The leadership determined that placing observation patients in a designated location would potentially reduce the prolonged wait times in the ED for an inpatient bed to open. The goal for the Observation Units is for patients to be discharged within 24 hours. With this goal in mind, the intent was to open the Observation Units where physicians, nurses and all ancillary teams could focus on each observation patient’s specific diagnosis to determine if they qualified for an inpatient admission or discharged to continue their care as an outpatient.

As we proceeded with the development of the Observation Units, resources from all departments in the organization were needed and every department was actively involved. The new Observation Units, 8100, 8200, and 8300, are located on the eighth floor of the Clover Leaf towers. We are licensed for a total of 76 beds on the three units combined. The Observation Units are currently open to admit up to 52 patients. Unit 8200 has 26 beds with telemetry capability, and Unit 8300 has 26 beds.

In preparation for the opening of the new observation units, we added and updated some of the equipment on the units. We held mandatory training sessions for the nurses transferring from the old Unit 8300 to the new observation units, and introduced and trained LVNs to be part of the team nursing on the observation units. Because patients with cardiac and transplantation conditions were to be cared for on these units, part of the training of the nursing staff was related to the nursing interventions required to care for these specialized conditions that were previously unknown to the RNs. The higher census and altered types of patients from the initial expectations resulted in the need for additional full-time positions in all departments to care for the higher census.

On most days, Units 8200 and 8300 are at full capacity. We are licensed to care for observation patients, however, due to the current suspension of regulatory enforcement of hospital requirements (AFL), we are also admitting and caring for inpatients. Therefore, our length of stay varies widely, from hours to some patients even staying months.

These new units are coordinating patient care at a fast pace with a high throughput of patients. This requires the nurses, RNs and LVNs, patient care assistants (PCAs), monitor technicians (MT), and the unit secretary (US), to band together as a team more than ever to ensure patients receive a bed as soon as it is available. Working alongside multiple services (MOD, DH, Cardiology, Transplant), coordinating patient admissions quickly, ensuring greater bed availability, while also dealing with confused patients only a few steps away from the nurse’s station, requires dedicated teamwork and communication. This team has pulled together quickly and continues to be excited and committed to ensuring high-quality care while also ensuring patients reduced time in the hospital observation setting.