New Clinical Decision Unit at Providence St. Vincent cares for patients needing observation

Jeremy R Krueger Jeremy Krueger, D.O., hospitalist unit director, Clinical Decision Unit, Providence St. Vincent Medical Center

Scott MarsalScott Marsal, M.D., FACP, division chief of medicine, Providence St. Vincent Medical Center

The Clinical Decision Unit (CDU) at Providence St. Vincent Medical Center in southwest Portland is a 26-bed unit designated for patients in observation status. This allows eligible patients to receive specialized care while their clinical team conducts assessments and determines whether they should be hospitalized or discharged. It also helps ease crowded emergency departments and reduces unnecessary hospitalizations.

The unit is open 24/7, provides full hospital services, and is staffed with RNs who have received special training in caring for observation patients. All rooms are equipped with telemetry monitoring capability, and a care manager is assigned to the CDU for rapid, personalized discharge planning. The unit is located one floor above the hospital ED and is the first CDU within Providence’s eight hospitals in Oregon.

Although the unit has been open only two months, the trend so far is that 80-90 percent of the CDU’s patients go home within 24 hours. The other 10-20 percent of patients remain in the unit another day or are admitted to the hospital for more serious conditions.

Services provided in the CDU

Co-locating most patients who are in observation status in one centralized care area provides several advantages. These patients receive specialized care, avoid prolonged emergency department stays while undergoing assessments, and are less likely to remain in the hospital unnecessarily. This eases emergency department crowding and reduces costs for everyone.

The CDU team provides interdisciplinary care in a patient- and family-centered care environment with direct patient care being provided by RNs and CNAs. Patients will receive any services ordered by their physician to help determine a diagnosis and appropriate treatment options.

During the first 24 hours in observation status, the attending physician determines whether the patient should remain in the hospital or be discharged home to follow up with a physician as an outpatient. The benchmark length of stay for observation patients is fewer than two midnights; however, patients may stay longer if they continue to meet medical necessity for observation level of care. Utilization management staff members perform case reviews on a daily bases for all patients in observation status. Observation services are tracked hourly instead of daily.

Admission criteria for the CDU

Admission to the CDU will be based on the medical necessity of each patient as determined by the attending physician and the hospital’s utilization management team, using nationally recognized criteria systems (such as InterQual).

Admission criteria include:

  • Meets InterQual criteria for observation status and the physician’s plan that the patient will be in the CDU fewer than two midnights 
  • Written, timed and dated physician order for placement in observation 
  • Clinical decision regarding inpatient admission or discharge expected within 24 hours 
  • Must be hemodynamically stable 
  • Nursing collaborates to review limited exclusion criteria also to be used when considering a patient for the CDU

To learn more

For questions or a tour, please contact the unit’s nurse manager, Laura Lightner at 503-216-8931 or Dr. Krueger.