I have no idea what the issues are that are causing continuity of care issues, or what you see as problems with that model. So please don't think I am criticising what you want for your facility. For mine, an acute care holding unit was a blessing.
There are often times of the year where the hospital is cram packed, so is the ER, and with a closed down "B WING" on 1st floor, I begged the idea of a "Holding Unit." I think it betters care, and moves the patient along "our" system better.
In the ER, only one family member can be present per patient. In AHU (Acute Holding Unit) they have even visiting hours 8am-10pm. Visiting lasts for 30 minutes, and it is strict, but I let new admits to the unit have 1 hour initially.
In the ER, you are only going to get fed if it's a DM issue, or similar. In AHU, if your not NPO for a test, you can have whatever Ordered Meal, and there are nice standby trays for After Hours-not in the ER.
In the ER, your laying on a stretcher. I think its cruel to leave the elderly on those things, lucky to have a pillow and blanket, and even luckier to have your curtain pulled for privacy. In AHU, you have a television, telephone, Brick walls beside you for privacy, and a Curtain in front of you. I turn the lights to dim at 10pm, so the unit is much quieter, much more stable feeling, and they have a bed, pillow, and all the ammenities of a room except a public bathroom that I make sure is spotless. It is cleaned on the hour even at night.
Since ALL floors have Universal Charting, (except ER), when one of my patients gets ready for a room, all their paperwork is done, and since ER lab does our labs, we get them quick (we draw all our labs). Its nothing for a patient to go to the floor 10-15 hours later with EVERYTHING DONE, all admitting lab, orders, and it just a simple pass off.
Furthermore, since we are attached to the ER, the ER benefits in less wait times, because you know how long a pt. can tie up a room waiting on a bed. We take ALL 24 hour ops. We are staffed for up to 3 1:1s, All tele capable, and 3 ICU wait beds (ICU nurse on unit comes from the unit), and it's amazing for cardiac patients who can be d/c'd usually after 3 neg Cardiac Enzymes without further orders. (imagine that patients experience if stuck in ER 15-20 hours! I Love It! And, even though the patients complain at first usually (not all), they appreciate it once they are admitted there, get food, a shower, and are in a quieter atmosphere with all their orders moving.
I know this isn't for everyone, but our ED was drowning, wait times were getting out-of-hand, and patient satifaction with our Emergency Department has gone up 49% The ER Docs like the unit (though they never get the name right, Lol! I would be so sad if we lost these 40 spaces to give our patients a better experience than ED.