Date of Award


Document Type


Degree Name

Doctor of Nursing Practice (DNP)

School Name

Donna and Allan Lansing School of Nursing and Health Sciences



Major Advisor

Dr. Sherill Cronin

Second Advisor

Dr. Christy Kane

Third Advisor

Dr. James Friazer


The Affordable Care Act has transformed our nation’s healthcare system and reimbursement structure. The paradigm shift to improve efficiency, quality and to lower has created evolving models to rapidly diagnose and treat patients presenting to the emergency department with chronic disease. Clinical decision units (CDU) have become a leading strategy for treating patients at an appropriate level of care. CDU use evidence-based protocol driven care according to different disease status. Patients assigned to these areas, are provided with rapid and safe evaluations for patients identified at low-risk. Reducingthe number ofpatients who arereadmitted to thehospital with COPD is a prioritywithin NHC. Hospitals must make certainthatsystemsand structures arein placeto ensure that patientsreceive the rightlevel ofcareat the right time andrightplace. Diagnosis specificobservation unitsare an innovativeapproach for providing an alternative level of care in which patients could benefit from an extended observation period. Studieshaveshown that OUs reduce re-admission rates, control cost, reduce the LOS, and impact the utilization of ED visits. Further research is recommended to identify other deliberate practices that can contribute to better outcomes.