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Clinical Decision Unit Delivers Impressive Return on Investment: Winter Haven Hospital Case Study

Case Studies

Adding a Clinical Decision Unit to the ED reduced length of stay and influenced bottom line revenue for Winter Haven Hospital


Hospital Information

Facility: Winter Haven Hospital – Winter Haven, FL

TeamHealth Services: Emergency Medicine

TeamHealth Impact

  • Decreased LOS for observation patients by as much as 17 hours
  • Reduced emergency department holds
  • Produced ROI of more than $5 million per year

“The Clinical Decision Unit has been a resounding success for our patients, physicians and the entire hospital. We are grateful to TeamHealth for their initiative and leadership on this project, as well as their ongoing partnership in providing outstanding care for the individuals we serve.” – Stephen A. Nierman, President, Winter Haven Hospital


Winter Haven Hospital is a 529-bed facility in Florida’s BayCare Health System. When the hospital began experiencing patient throughput challenges it called on its emergency medicine partner, TeamHealth, to develop solutions. The hospital’s 51-bed emergency department (ED) was holding 20 or more patients every day while waiting for beds to open on the hospital floor, negatively affecting patient flow and the timeliness of care delivered in the ED. The only options seemed to be building a new patient tower to increase physical bed capacity or finding a way to create functional capacity by improving inpatient throughput and bed availability.


Working collaboratively, TeamHealth and Winter Haven Hospital determined creating a Clinical Decision Unit (CDU), commonly called an observation unit, would create the functional capacity the hospital needed without the time and expense associated with physical expansion. Since the hospital was already in the process of building a new ED, it remodeled some space from the old ED – located just next door – for a 14-bed CDU. This unit, run by ED clinicians, is designed as a central location for patients being held for observation. Previously, these patients were dispersed throughout the hospital to any available bed, making it difficult for the hospital medicine team to round on and discharge or admit them in a timely fashion. As a result, patients remained in observation status for an average of 36 hours, significantly beyond the 24 hours for which the hospital receives a fixed reimbursement rate for observation care.

With the CDU, physicians can more easily monitor observation patients and make timely decisions about their care. In addition, the hospital medicine and emergency medicine teams have worked with all ancillary services, such as cardiology, radiology and neurology to develop standard care protocols by diagnosis and establish agreed-upon turnaround times for test results, imaging and consults. Now, when patients present with chest pain, dehydration or other diagnoses, physicians in the CDU follow standard workups to quickly evaluate the patient’s health and determine whether to discharge or admit. This new process ensures there are no unnecessary tests and nearly eliminates the need for consults.


In the nearly one year since the CDU opened, it has produced significant results. The implementation of standardized care protocols has lowered unnecessary resource utilization, eliminated unnecessary consultations and dramatically reduced length of stay. The nearly 350 patients treated in the CDU each month now have an average length of stay of just 17.4 hours. Winter Haven jumped from last place to first among the BayCare system’s 15 hospitals for observation length of stay.

The reduced LOS and enhanced resource utilization led to an impressive return on investment for the hospital – estimated at approximately $5 million per year. In addition, the increased functional capacity allows patients to flow from the ED to the hospital floor more efficiently, reducing ED holds, the number of patients who leave without treatment and other important operational metrics.


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