Commissioning a Short Stay Observation Unit (SSOU) in a children’s facility within a Dublin Academic Teaching Hospital.

This change project involves the commissioning of a Short Stay Observation Unit (SSOU) within a DATH’s Hospital.

SSOU’sdeliver intensive short-term assessment, observation or therapy to selected ED patients to optimize early treatment and discharge. Observation medicine in dedicated units is a feature of many adult Emergency Departments (ED) but this has not been reflected in children’s ED’s in Ireland.

The current literature supports the development of SSOU’s, indeed it is very much in line with the new National Model of Care for Paediatrics in Ireland and the new National Children’s Hospital.

Developing a unit can be challenging and there is much to be considered when selecting the governance structure, choosing suitable conditions, staffing and developing metrics to help monitor its performance post opening. The creation of this new unit required a cultural change with regard to how care is delivered within the hospital. This required a change to the “day to day” practices of the consultants and nurses. Such changes can be difficult in large, complex healthcare organizations. However, the underlying assumption of this project is that the patient comes first and that SSOU’s are designed to prioritise the patient and not staff, management or finances.

The rational for the change is to streamline ED services by transferring observational patients from ED to the SSOU thus reducing ED waiting times and inpatient admissions. The HSE Model of Change (2008) was used to guide and manage the change process. The projected was evaluated against the project objectives, a nursing survey (n=55) and nurse management focus group (n=5) was also used to evaluate the success of the project. The results indicate that although staff have some concerns with regard to the development 71% (n=39) would be interested in redeploying to the unit upon its opening.

The study also identified a potential saving of 6-7 inpatient beds per day with an operational SSOU. SSOU’s have been shown to reduced hospital length of stay and costs while increasing parental satisfaction.

Finally, the author discussed the findings of the project in light of the current literature and from the experience of undertaking the project. The strengths and limitations are identified and recommendations for the organisations are documented.