Care management unit reduces ED crowding.

SAN FRANCISCO -- A seven-bed care management unit in an emergency department reduced overcrowding by trimming the number of patients admitted to the hospital or waiting for telemetry beds, a pilot study of 1,325 patients found.

One factor in the national crisis of emergency department overcrowding is the slow transit of patients being admitted to the hospital. They often spend more than 24 hours in the emergency department, Dr. Varnada A. Karriem-Norwood said in a poster presentation at the annual meeting of the Society for Academic Emergency Medicine.

Dr. Karriem-Norwood and associates at Emory University, Atlanta, conducted a prospective study of patients admitted from the emergency department to a care management unit for asthma, chest pain, heart failure, or hyperglycemia between August 2003 and April 2004. Four case managers available in the unit 24 hours each day coordinated a care plan with a physician, educated patients, filled prescriptions, entered patient information into a database, arranged follow-up, and maintained phone contact with patients.

The care management unit successfully discharged about 87% of patients, admitted 13% to the hospital, and transferred three patients (less than 1%) back to the emergency department. The concept could be introduced at other hospitals, the investigators said.