The University of Chicago Medicine (UCM) is a major academic medical center, nationally ranked for its specialty services. When UCM recently constructed two previously shelled floors in its four-year-old Center for Care and Discovery, the institution worked with Albert Kahn Associates to reconfigure the typical patient unit floor plan to locate 22 observation beds with toilets and showers, but without windows, in the center of the floors. These floors house the digestive disease and heart/vascular service-line patients.

"The intent behind this integrated model is to enable the clinical care teams to be able to consistently and conveniently care for patients at all levels of care," says Debi Albert, chief nursing officer. "We took a service-line approach to the patient cohorting process such that we have critical care, inpatient telemetry, medical-surgical and observation status on the same floor plate. This allows the team to more easily manage patient care across the acute care spectrum with nurses who are equally skilled in the care of specific service-line patient populations.”

When procedural recovery areas close for the day, patients are relocated to these floors for overnight stays if required. Outpatient observation is managed in hour-by-hour protocols to send patients home as soon as medically feasible. One challenge for nurses who manage both classifications of patients is that documentation for outpatients vs. inpatients is significantly different. UCM is also considering opening a trauma observation unit adjacent to its new Level I trauma emergency department to accommodate short-stay patients, who contribute to 50 percent of its trauma volume.