Eastern Visayas Regional Medical Center

Best Practice Focus Area/s

Strategy, Citizens / Customers, Operations

Year Implemented

15 October 2018 to present

This is a GBPR finalist entry


The Eastern Visayas Regional Medical Center (EVRMC) Department of Emergency Medicine formed the Emergency Medicine Observation Ward (EMOW) with the approval of the Medical Center Chief. It was inaugurated on 15 October 2018. The ward aims to decongest the overcrowded emergency room. The observation and assessment ward allows patients to be observed short-term and permits patient monitoring and treatment for at least 24 hours. It is a fifteen (15) bed capacity ward that caters to patients with simple diseases such as Acute Gastroenteritis, Bronchial Asthma, Hypertensive Urgency, etc., and patients who require social admission.

Background and Problem

The EVRMC is a tertiary, teaching-and-training, end-referral hospital with an authorized bed capacity of five hundred (500) (but implementing on a 1,000-bed capacity) that provides comprehensive quality healthcare services for the people of Region VIII. It has fourteen (14) departmentalized clinical services with eleven (11) residency training programs accredited by their respective specialty societies.

As the end referral hospital in Region 8, patients from all walks of life choose to come to the EVRMC Department of Emergency Medicine, ranging from simple cases to complicated ones. Currently, the Department of Emergency Medicine still admits simple cases to the Emergency Medicine Observation Ward up to the present. This results in the congestion of the Emergency Room. Utilizing the Emergency Medicine Observation Ward in the ER helps alleviate the overwhelming influx of patients seeking immediate medical attention. From its inauguration to this time amidst this Covid-19 pandemic, the EMOW did not stop its implementation. The Emergency Observation Ward was created to address patients’ needs, decongest the emergency room, and lessen the number of overstaying patients at the ER.

Solution and Impact

It has been a policy of the Department of Emergency Medicine that all disciplines abide by and utilize the Emergency Medicine Observation Ward. EMOW staff/residents on duty must manage all cases, and patients must be triaged and managed. For cases that theEMOW sta can’t manage, they will be referred to the appropriate discipline concerned. This ensures easy disposition of cases, whether the patient is for admission or discharge. Hence, decongestion, turn-around-time, and client satisfaction are met.

All patients/clients are admitted to EMOW since it’s a strict ER policy. Implementing the EMOW results in decongestion of the ER, lessens turn-around time, and improves client satisfaction. Clients enjoy the lesser turn-around time that the implementation of EMOW produces. Evidence suggests that with patients admitted to the Emergency Medicine Observation Ward, the ward reduces patients’ length of stay and satisfies the target four-hour stay in the Emergency Room. Emergency Department patients do not have to wait for vacancies in the significant clinical wards to be admitted. Patients who fit the criteria for admission to the EMOW do not have to wait for laboratory results at the ER, thereby decongesting the ER. This, in turn, lessens the number of overstaying patients, thus satisfying the target four-hour stay in the emergency room and increasing customer satisfaction.

Use of EMOW resulted in decongestion of the ER, lessened turn-around time, and improved client satisfaction. For financial benefits, patients enjoy lesser expenses because there is a disposition within 24 to 48 hours from admission to EMOW. The hospital can reimburse costs incurred from PhilHealth packages. The adoption of the Emergency Medicine Observation Ward (EMOW) can be benchmarked by other hospitals/institutions to improve their turn-around time, thereby increasing Client Satisfaction. The Department of Emergency Medicine still adopts patients’ admission to the Emergency Observation Ward (EMOW).

Milestones/Next Steps

Since its inauguration last 15 October 2018, the Emergency Medicine Observation Ward is still being implemented up to the present. After the implementation of the Emergency Medicine Observation Ward (EMOW), the ER patient turn-around time improved, and there was an increase in the Client Satisfaction Rating.

Before the implementation and adoption of EMOW, the Emergency Room of EVRMC was very crowded, catering to at least 4,744 patients monthly for 2018, and concern for lesser turn-around-time was not considered because this is not yet a target in the DOH performance indicator. In 2019, the patients seen at the ER totaled 47,737. Among these patients, 90.39%were seen with less than 4 hours turn-around time.

For 2020, the DOH performance indicator requires a 95% target for ER patient turn-around time. The hospital attained 94% as of 30 June 2020, compared to 90.93% the previous year. Due to the increasing census at the EMOW, the management plans to increase its bed capacity from 15 beds to 20-bed capacity by 2020.