Project Director

Crowe, William C.

Department Examiner

Hungenberg, Eric


School of Professional Studies


University of Tennessee at Chattanooga

Place of Publication

Chattanooga (Tenn.)


The rising demand for acute care is attributable to several factors, including poor access to unscheduled primary care and an aging population with complex chronic illnesses which place an increasing demand on crowded ED and hospitals in the United States (American College of Emergency Physicians, 2009). Observation (OBS) services are provided to patients with an acute clinical condition whose need for acute care hospitalization is unclear after their initial evaluation and management. Center for Medicare & Medicaid (CMS) define hospital observation as those services that are reasonable and necessary to evaluate the outpatient's condition whose need for the patient to be admitted to the hospital as an inpatient (CMS, 2011). The observation unit (OU) provides an intense, focused care management program configured for safety, quality and efficiency. Clinical oversight of the unit is co-management model provided by a Hospitalist and advanced practiced registered nurse. Evidence based practices such as multidisciplinary rounds, bedside shift report, and unit huddles are used to impact LOS, emit a reduction in cost, enhance patient throughput and therefore yield a decrease in patients leaving the emergency department prior to medical screening. Creating a dedicated area within a hospital to cohort observation patients is an essential best practice that enables safe and efficient care. As national and local trends continue to increase demand for observations services, clinicians increasingly understand the benefits of an OU. Observation units are dedicated units built to provide efficient protocol-based care to patients with well-defined diagnoses or presenting symptoms such as asthma, transient ischemic attack (TIA), and congestive heart failure (CHS). Only approximately one-third of US hospitals currently have an observation unit. The purpose of this research is to identify OU as the best practice (Emergency Medicine Clinics). The data will be looked at through the hospital X’s data platform Tableau. Throughout the research, any changes to make the OU as the ideal place to be will done through the patient throughput committee which oversees the changes. With an observation unit, how do multidisciplinary rounds, bedside shift reports, and unit huddles effect patient throughput. This research however has taken a twist as Covid-19 didn’t let the observation unit implemented at hospital X run at full capacity at any point in time unfortunately, but the results of the units and ED observation services will be looked at.


B. S.; An honors thesis submitted to the faculty of the University of Tennessee at Chattanooga in partial fulfillment of the requirements of the degree of Bachelor of Science.




Hospitals--Emergency services; Hospitals--Observation units


ED overcrowding; Observation; Observation unit; Patient throughput


Health and Medical Administration

Document Type



24 unnumbered leaves