Observation Services

The Observation Services at Mount Sinai Hospital, led by Dr. Jonathan Yeo, MD, provide short-term treatments and ongoing evaluation for various conditions like asthma, CHF, chest pain, and more. The dedicated unit offers 24/7 care with a nursing ratio of 5:1 and physician oversight. The team ensures patients receive timely care within a 8 to 24-hour window. With monthly metrics showcasing patient volume and outcomes, the hospital emphasizes patient safety and effective care pathways.

• Hospital Services
• Patient Care
• Medical Evaluation
• Mount Sinai
• Jonathan Yeo

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Uploaded on Feb 18, 2025 | 0 Views

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1. Observation Services Mount Sinai Hospital Jonathan Yeo, MD

2. Introduction Short-term treatments (asthma, CHF, etc.) Ongoing evaluation (chest pain, syncope, etc.) Does not meet inpatient criteria Can not be discharged from the ED Requires 8 to 24 hours of care (up to 48 hours) 2

3. Observation Unit at MSH Dedicated unit with 20 bed capacity 24/7 double midlevel coverage ED Physician Assistants Hospitalists as physician oversight 5:1 Nursing ratio 24 hours SW coverage 12 hours/day CM 7 days/week PT consults Hospital beds provided for elderly patients 3

4. Current Pathways 1. 2. 3. 3. 4. 4. 5. 6. 7. 7. 8. 8. 9. 10. 11. 12. 13. 14. 15. Abdominal Pain Allergic reaction Anemia/Transfusion Anemia/Transfusion Asthma Asthma Atrial fibrillation Back pain Cellulitis Cellulitis Chest pain Chest pain CHF COPD Dehydration/vomiting/diarrhea Dialysis Drug/Alcohol Intox/withdrawal DVT GI bleed 16. 17. 18. 19. 20. 21. 22. 23. 23. 24. 25. 26. 27. 27. 28. 29. 30. 30. Head Injury/TBI Headache Hyperglycemia Hypoglycemia LVP Pneumonia Pulmonary Embolism Pyelonephritis Pyelonephritis Renal colic Seizure Sickle cell Syncope Syncope TIA Vertigo OTHER OTHER 4

5. Metrics Monthly volume: 350 400 patients Average LOS: 20 24 hours Average admission rate to inpatient from observation: 20% 1/3 patients are NON pathway Complex social cases Subacute rehab placements to skilled nursing facilities 30 day readmission avoided: 25 40 per month 5

6. The Role of Social Work in the Emergency Department Maya Genovesi, LCSW MPH Associate Director Social Work Emergency Department Social Work

7. Our Team & Our Role We have Social Workers & Care Coordinators on our team Social workers: Complete psychosocial assessments and to provide psychosocial/supportive counseling. With your help, we assess and meet with patients to: Determine and discuss discharge options to make the safest possible, least restrictive plan Facilitate referrals to community agencies Ensure patients have needed access to medication Arrange homecare & placement (only if required & needed) Care Coordinators: Assess barriers to engagement in primary & specialty care Effectively schedule primary & specialty appointments

8. What can Social Work help with? Patients who are having a hard time coping in the community due to: Change in baseline functioning Frequent falls Limited social supports Patients who have difficulty engaging in primary care due to: Difficulties with transportation Insurance issues Patients experiencing mental illness & substance abuse Patients experiencing abuse, neglect, or trauma Cardiac arrests & traumatic loss 8

9. What can do we do to help? Meet with patients to establish rapport and understand: How are they understanding their lives/ the problem ? What we can do to assist? Provide crisis/emotional support Connect patients to: Community resources & referrals, including: Social Work in the Community Detox, rehab, mental health resources Resources to assist in accessing insurance Shelter, food pantries, drop-in centers Home health aide & nursing services Sub-Acute Rehabilitation or Skilled Nursing Facility Home with Home Hospice/Transfer to Inpatient Hospice Facility

10. Types of Home Care Referrals We refer patient for home care for: Physical therapy Wound Care Home IV antibiotics Medication reconciliation Disease Education and Teaching Home safety assessment Social Work Assessment We also refer patients to: Visiting doctor programs Home Hospice/ palliative care

11. Placement from the ED/ RETU If medically appropriate and socially feasible, we can discharge patients directly to nursing facilities, most commonly for physical rehabilitation If you think a patient isn t faring well in the community- ask us and we will make the best & most safe plan with you! We consult physical therapy (PT) in the ED! They can be consulted in ALL ED AREAS- you don t need to admit to RETU for a PT evaluation You do not need to consult PT if you think the patient can walk- we can help you get durable medical equipment & refer to home or outpatient PT without a consult. 11

12. Cases of Abuse or Neglect The medical team is required to notify Social Work of all protocol cases Protocol cases include: Expirations in the ED Intimate Partner Violence/Domestic Violence Sexual Assault Physical Assault Suspected elder abuse or neglect In these cases, we: Provide trauma-focused crisis counseling & support Contact police (if indicated) Assist patients with make the safest plan possible 12

13. Thank You!