The Mount Sinai Hospital is the first in New York City to open an observation unit for Emergency Department (ED) patients who do not meet criteria for inpatient admission, yet require further short-term evaluation and treatment before they can be discharged safely. The 20-bed Rapid Evaluation and Treatment Unit (RETU) is adjacent to the ED and is staffed by physicians, physician assistants, nurse managers, nurses, case managers, and social workers who work as a team to better assess and coordinate patient care. Similar units will be rolled out at hospitals throughout the Mount Sinai Health System in the coming months.

The RETU is most appropriate for patients who, after evaluation by an ED attending, require time for further diagnostic testing and/or treatment in order to determine whether they will require inpatient admission. This includes patients who need continued evaluation for a transient ischemic attack, for example, a heart attack, unstable angina, or hypoglycemia. It also benefits patients who need to be monitored closely as they receive short-term treatment for conditions such as asthma, or those who need coordinated care after discharge.

“This unit provides us with dedicated space and resources to more thoroughly evaluate and treat conditions that historically have required a short-stay hospital admission,” says Luke Hermann, MD, Director of Observation Services for the Health System. “By using standardized evaluation and treatment protocols, and placing an emphasis on early and aggressive care coordination, we are able to address complex social service needs when they exist and provide a level of post-discharge care that will truly benefit all of our patients.”

The RETU is staffed 24 hours a day. It is not meant to care for patients who need or have had a procedure, or ED patients in transition to an inpatient bed. Typically, approximately 80 percent of patients cared for in the RETU will be medically stable for discharge within 24 hours, while the remaining 20 percent will require inpatient admission for further hospital care. More than 600 patients have been evaluated in the RETU since it was created in mid-February.

“Providing high-quality, efficient, and patient-centered observation services throughout our Health System is critical to our ability to manage populations of patients over time in a fee-for-value system,” says Jeffrey Farber, MD, MBA, Vice President, Hospital Services Utilization, Mount Sinai Health System. “Construction is already under way for observation units at Mount Sinai Beth Israel, Mount Sinai St. Luke’s, and Mount Sinai Roosevelt.”