Chest Pain Obs Unit... anybody? opinions?

[DaisyRN, ACNP]

hey all.

i have been loving my job, but recently caught wind of the "bosses" wanting to pull me out of the hospital for lack of reimbursement (as compared to the clinic), and quite frankly... i don't want to be pulled out of the hospital. that is why i am an acnp. not an fnp. or an anp. i was talking with the cardio director of the hospital (for whom i work fairly closely) and she proposed i talk with the ceo about a position for me permanently in the hospital. well, that'd be great and all... but i don't wanna tick of the cardiologists i am working with now because it is a small town. i would like to keep an amicable relationship with them. so, my thought is what about a chest pain obs unit... like a "rule out" place. i would be the primary overseer of the unit, managing labs, monitoring for changes, discharging, supervising stresses, etc. with the collaboration of one of the cardiologists. i know these units are out there... and i'm not talking about a regular imc unit... i mean a smaller unit solely for chest pain pts. sometimes these are based out of the er (which is where my background is)... and the hospital i am spending a lot of time in has talked about setting one up in the past. i suppose an alternative would be that i went around to all the chest pain patients scattered everywhere and do the same thing.

questions:

1. what determines the success of these units?

2. how could i propose this idea where it would benefit the cardiologists that i work with, so they wouldn't think i was betraying them by going to the hospital... and how could i propose it so the hospital would pay me sufficiently and make the most of my time?

and off the wall: how can you improve "productivity" if the reimbursement is so poor in the hospital setting?

[Corey Narry, MSN, RN, NP]

1. Chest pain units, Observation Units, or Clinical Decision Units are successful no doubt. There are many mid-level positions for these units where I live. However, most of these types of units I'm aware of are run by either Emergency Medicine or a Hospitalist Service, not Cardiology. Patients who are admitted to these units, as you are aware, come to the ER with chest pain but have no emergent indication to be catheterized. They are typically admitted for a R/O ACS protocol with a stress test. Only when the patient comes back with a positive result is the time Cardiology is involved and the patient is admitted to Cardiology.

2. Having said what I said in #1, I do not know how you may be able to convince the Cardiologists to work in this unit without having to jump ship and work for another service. Although, maybe you can ask if you can be the Cardiology person the Obs Unit calls for all positive stress test patients and you can do the consult and the admission process for these patients. That may be worth a try?

[DaisyRN, ACNP]

well, those are good points. and the way the service here works, is cardiology is consulted inappropriately... most of the time. i guess i was thinking by me supervising that unit, i would minimize the inappropriate consults. hmm...

[Corey Narry, MSN, RN, NP]

well, those are good points. and the way the service here works, is cardiology is consulted inappropriately... most of the time. i guess i was thinking by me supervising that unit, i would minimize the inappropriate consults. hmm...

true, but maybe they'll ask how that would generate revenue for your service. it's all about the money sometimes.