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Improvements in Medical Care after Implementation of a Holistic Care Unit at a Medical Center in Taiwan

Meng-Chieh Wu, Chun-Cheng Zhang, Tzu-Chieh Weng, Hsin-Kai Huang, Chien-Chin Hsu, Cheng-Fa Yeh, Tsung-Hsun Liu, Shang-Yu Lee, Yung-Ze Cheng, Li- Sheng Chang and Kao-Chang Lin

Objective: A medical center in Taiwan established a Holistic Care Unit (HCU) in the emergency department (ED) to care for emergency patients while they wait for admission. Its goal was to prevent patient conditions from worsening, shorten the ED length of stay for admission, reduce complaints and disputes, and raise the quality of care.
Design: If emergency physicians suggested that a patient be admitted, the patient was then transferred to the HCU. The 24-hour work day for the HCU was split into three eight-hour shifts during which on-duty physicians continued any unfinished treatments or follow-ups and accepted new patients.
Results: The HCU's intervention in the ED and coordination with inpatient care significantly reduced the rate of access block from 55.29% to 50.01% (p<0.01). In addition, the ED length of stay for admission was significantly decreased from 17.06 hours to 14.13 hours (p=0.018). The percentage of patients whose condition improved while waiting for admission to the ED and who could then be released after treatment by the HCU rose from 1.3% to 4.3%.
Conclusions: The HCU at this medical center is the first of its kind to combine emergency and inpatient care in Taiwan. Overcrowding was improved after establishment of the HCU at our hospital.