Written by Mary Marschner
Spoon Feed
A flexible short-stay unit (SSU) run by hospitalist/APP service to complement a traditional workflow resulted in patients with average lower length of stay (LOS) and shorter stays in the ER.
It’s not an admission, not observation…it’s a short-stay unit!
As our healthcare system continues to devolve, with less access to primary care, more underinsured patients, and closures of smaller facilities, our emergency departments and hospitals are becoming overcrowded.
This study addresses ED overcrowding by assessing the impact of a hospitalist-run short-stay unit (SSU) on patient throughput and LOS. Implemented in October 2022, the SSU accepts patients needing <48 hours of care, regardless of diagnosis or admission status. The study compared data from before (Jan-Sept 2022) and after (Nov 2022-Oct 2023) the SSU implementation. SSU patients experienced a 71% efficiency gain in ED throughput. The SSU also saw decreased LOS for common diagnoses. For example, the median time from admission order to ED exit went from 720 minutes for non-SSU patients to 207 minutes for SSU patients.
Implementing this broadly will have challenges. It still requires hospital beds to move patients out of the ER, nursing staff, providers, social workers, and case managers. Creating a unit that prioritizes resource allocation to SSU patients is no small operational challenge.
How does this change my practice?
I am always in favor of novel ways to address bottlenecks in a hospital system. This is a twist on observation units and chest-pain units; it uses higher patient volumes to segment patients and treat them more efficiently by identifying patients with limited medical complexity who could be rapidly discharged and prioritizing their throughput. I think this model could work especially well in community hospital settings and appreciate how it decreased ER boarding time. I worry that this model may not be effective in a large academic medical center with a high volume of complex patients or at a transplant center.
Source
Development of a hospitalist-run short-stay unit to improve throughput and reduce length of stay. J Hosp Med. 2025 Feb;20(2):209-213. doi: 10.1002/jhm.13532. Epub 2024 Oct 16. PMID: 39411886
