Abstract
Aim: To highlight an academic cancer center’s approach to providing comprehensive care by utilizing a short-stay outpatient observation unit. Background: The Clinical Decision Unit (CDU) is a 16 bed observation unit that focuses on problem-based patient symptom management in collaboration with the primary oncology services. Design: Staffing—The CDU is staffed continuously by two Advanced Practice Providers (APPs), scheduled in alternating 12 hour shifts, with an on-call medical director for clinical and operational support. The APPs are from two existing programs that provide various inpatient and procedural services throughout the hospital. Intake/Placement—While the emergency center is the primary entry point for patients being placed in the CDU, outpatient clinics and procedural areas also request placement into the unit. The requesting service or designee makes the request for observation based on the clinical presentation at the time of the recommendation and medical necessity. Services—Once placed in the CDU, the APPs perform an initial assessment followed by patient care planning, including, a problem-focused history and physical, medication reconciliation, order management, expedition of consulting services or diagnostic exams and therapeutic procedures, where applicable. The APPs assess the patients every four to six hours to evaluate and document interim progress and make decisions on disposition. Findings: Placement Diagnoses—Patients placed in the CDU present with symptoms that are suitable for observation management and are at different phases of oncologic treatment. The most common diagnoses are: pain (categorized as pain of any kind), nausea/vomiting, anemia, and dehydration. Primary Service Utilization—A number of different primary oncology and surgical services populate the CDU. The top 5 services that house patients in the CDU are medical oncology services that provide treatment for solid tumor patients. Disposition Outcomes—From August 2015-June 2016, nearly 80% of patients placed in the CDU were discharged home versus those requiring an inpatient admission. Summary: Since its commencement in November 2014, the CDU has been a beneficial addition to patient care services by managing symptoms of patients who would have previously been hospitalized or forced to wait for a clinic appointment. The CDU provides dedicated, problem-focused care to patients, while emphasizing continuity of patient care by collaborating with primary oncology teams, to provide outpatient observation management services that aims to not only avoid an unnecessary hospital stay, but to also bridge any necessary care between scheduled clinic visits.
