Patterns of Use of an Emergency Department-Based Observation Unit

Abstract

Emergency department (ED)-based observation units are becoming increasingly used for the assessment and treatment of patients who may not require inpatient management or monitoring. This is a retrospective study of 5,714 patients seen in an ED observation unit from October 16, 1996 through July 12, 2000. Of the 5,714 patients seen in the observation unit, 4,191 were discharged and 1,314 were admitted. The average length of stay was 14.92 hours. The largest group of patients seen in the observation unit was those with chest pain (almost 26%). Patients suffering abdominal pain/colic represented the second largest group (almost 16%). Pediatric patients had the shortest stay, averaging only 11.2 hours, although adult and geriatric patients averaged 15.1 hours and 15.4 hours, respectfully. The ED-based observation unit can be of great value to patient care. Although not a substitute for an inpatient unit, it is meant to be a convenient location from which to observe patients who exhibit questionable admitting criteria.

Smoking cessation among patients in an emergency chest pain observation unit: Outcomes of the Chest Pain Smoking Study (CPSS)

“…These patients are receptive to smoking cessation intervention, and yet they may be more vulnerable to relapse than hospital inpatients because of the brevity (,24 hours) of the observation unit admission. Since chest pain is one of the most common presenting complaints to hospital emergency departments (McCaig & Burt, 2004;Hostetler et al, 2002), and smokers comprise a substantial proportion of the population, broad application of smoking interventions in the observation unit could reach millions of smokers per year. Targeting treatment for these smokers could have a substantial impact on public health.…”

“…Using advanced diagnostic tests, clinicians are able to diagnose acute myocardial infarction within a 24-hour time frame, facilitating the development of observation units for chest pain patients who have a low-to-moderate probability of myocardial infarction at the time of their presentation to the emergency department (American College of Emergency Physicians, 2000;Hostetler, Leikin, Timmons, Hanashiro, & Kissane, 2002;Zalenski et al, 1997). Approximately 90% of these patients are ruled out for myocardial infarction or other serious cardiac events (American College of Emergency Physicians, 2000; Grijseels et al, 1995;Hostetler et al, 2002).…”

Protocol-Driven Emergency Department Observation Units Offer Savings, Shorter Stays, And Reduced Admissions

“…The performance of the three Atlanta hospitals' observation units was consistent with the performance of type 1 units reported in previous studies and national surveys. 7,[15][16][17][18][19] Applying the length-of-stay achieved by the Emory/Grady type 1 units to statewide data would lead to a 38 percent reduction in the length of observation visits in Georgia. Applying the type 1 unit length-of-stay to national data would lead to an estimated 23 percent reduction.…”

Best Practices for Improving Flow and Care of Pediatric Patients in the Emergency Department

“…The types of patients best served in these units include those with asthma, croup, gastroenteritis, dehydration, abdominal pain, and poisoning. [104][105][106][107][108] If the ED space and staffing are insufficient to adequately justify either an urgent care or observation service, another model can be used. A hybrid unit can be successfully created by sharing or combining resources with general pediatric inpatient or other pediatric outpatient services.…”