Principles of Observation Medicine

Ross, Michael A.; Graff, Louis

doi:10.1016/s0733-8627(05)70165-6

Cited by 43 publications

(31 citation statements)

References 38 publications

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“…O bservation units (OUs), also known as shortstay units or rapid treatment units, are dedicated areas where patients may be treated or observed for a defined time period to determine the need for inpatient admission. [1][2][3][4] By offering evaluation and treatment beyond that provided by an emergency department (ED), OUs have the potential to improve the quality of medical care while reducing inpatient admissions, liability, and health care costs. [5][6][7][8][9][10] Many OUs function as "hybrid" units serving 2 very different types of patients within 1 physical setting: (1) acutely ill and injured "observation" patients and (2) scheduled elective procedure patients.…”

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confidence: 99%

The Pediatric Hybrid Observation Unit: An Analysis of 6477 Consecutive Patient Encounters

2005

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ABSTRACT. Objectives. Pediatric observation units (OUs) are becoming more common in hospitals throughout the United States, providing physicians with a new disposition option for children who are judged to be too ill for home management. Some OUs function as "hybrid" units, serving both acutely ill and injured observation patients as well as scheduled elective procedure patients. How best to utilize this new resource is not yet defined. We studied the utilization of our pediatric hybrid OU during the first 2 years of operation to determine (1) the spectrum and frequency of diagnoses treated, (2) diagnoses and procedures most (and least) likely to attain discharge successfully within 24 hours, and (3) whether age was associated with inability to be discharged from the OU within 24 hours.Methods. The study setting was a 20-bed hybrid OU located in a pediatric tertiary care hospital in Salt Lake City, Utah. The records of all patients admitted during the first 2 years of OU operation, from August 1999 through July 2001, were examined retrospectively.Results. There were 6477 OU admissions: 4189 (65%) for acutely ill and injured observation patients and 2288 (35%) for scheduled elective procedure patients. For the observation patients, median age was 2.5 years and median length of stay was 15.5 hours. Common admission diagnoses in these patients included enteritis/dehydration (n ‫؍‬ 722), orthopedic injuries (n ‫؍‬ 362), asthma (n ‫؍‬ 327), closed head injury (n ‫؍‬ 289), urgent transfusion/ infusion (n ‫؍‬ 221), bronchiolitis (n ‫؍‬ 212), croup (n ‫؍‬ 207), abdominal pain (n ‫؍‬ 199), cellulitis (n ‫؍‬ 177), and nonfebrile seizure (n ‫؍‬ 98). Overall, 15% of observation patients required subsequent inpatient admission for >24-hour stay. Observation diagnoses that were most likely to require inpatient admission were hematochezia (60%), viral pneumonia (46%), and bronchiolitis (43%). We demonstrated successful OU discharge rates (>85%) for several diagnoses not commonly reported: neonatal hyperbilirubinemia, aseptic meningitis, and diabetic ketoacidosis in the patient with known diabetes. Among the scheduled elective procedure patients, median age was 5.0 years and median length of stay was 3.0 hours. Only 1% of these patients required subsequent inpatient admission. In both populations, age <30 days was associated with increased need for inpatient admission, with a relative risk of 1.9 (95% confidence interval: 1.4 -2.6) among the observation patients and 13.9 (95% confidence interval: 3.0 -65.0) among scheduled procedure patients.Conclusion. Our pediatric hybrid OU played an important role in the treatment of children who were admitted for observation as a result of acute illness or injury, as well as children who required scheduled procedures. For both patient types, we identified diagnoses that are most and least likely to attain successful discharge within 24 hours. The majority (85%) of observation patients were discharged successfully within 24 hours. Successful discharge rates for diagnoses that are not common...

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confidence: 99%

The Pediatric Hybrid Observation Unit: An Analysis of 6477 Consecutive Patient Encounters

2005

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“…The primary outcome was clinical failure of OU treatment, defined as presence of one or more of the following: 1) any unexpected hospitalization to the ward directly from the OU, 2) return ED evaluation after discharge from the OU within 72 h, 3) if not performed in the ED, need for an initial I + D, or repeat I + D after OU admission, or 4) change in antibiotic therapy due to poor clinical response, as determined by investigator chart review of the admission.…”

Section: Main Outcome Measurementioning

confidence: 99%

“…Observation units provide treatment within specified areas for longer periods than typical ED visits, but shorter than full inpatient admissions (1)(2)(3). Obviating inpatient hospital services through observation results in reduced length of stay (LOS) and hospital costs (1,4,5).…”

Section: Introductionmentioning

confidence: 99%

“…Obviating inpatient hospital services through observation results in reduced length of stay (LOS) and hospital costs (1,4,5). Ideal clinical conditions for OUs are those that can be treated rapidly, have focused care goals, and require a low intensity of service (3). Common pediatric illnesses successfully treated in ED OUs include asthma, croup, and dehydration (1,2,(6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

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Failure of Emergency Department Observation Unit Treatment for Skin and Soft Tissue Infections

Mistry

Hirsch

Woodford

et al. 2015

The Journal of Emergency Medicine

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“…Most observation units are managed by emergency department personnel [3,4]. Usually, patients stay for less than 24 h before being discharged home or admitted for psychiatric treatment [5].…”

Section: Introductionmentioning

confidence: 99%

Utilization of Observation Units for the Care of Poisoned Patients: Trends from the Toxicology Investigators Consortium Case Registry

et al. 2015

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Many poisoned patients may only require a period of observation after their exposure. There are limited data describing the use of observation units for managing poisoned adult and pediatric patients. We performed a retrospective review of all patients reported to the ToxIC Case Registry between January 1, 2012 and December 31, 2013. Eligible patients included those who received a bedside consultation by a medical toxicologist and whose care was provided in an observation unit, or those who were admitted under the care of a medical toxicologist in an observation unit. A total of 15,562 poisonings were reported to the registry during the study period, of which 340 (2.2 %) involved patients who were cared for in an observation unit. Of these patients, 22.1 % were 18 years of age or younger, and the remaining 77.9 % were greater than 18 years of age. The most common reason for exposure was the intentional ingestion of a pharmaceutical agent in both adult (30.2 %) and pediatric patients (36.0 %). Alcohols (ethanol) (24.9 %), opioids (20.0 %), and sedativehypnotics (17.7 %) were the most common agent classes involved in adult patient exposures. The most common agent classes involved in pediatric exposures were antidepressants (12.0 %), anticonvulsants (10.7 %), and envenomations (10.7 %). In adult patients, the most common signs and symptoms involved the nervous system (52.0 %), a toxidrome (17.0 %), or a major vital sign abnormality (14.7 %). In pediatric patients, the most common signs and symptoms involved the nervous system (53.3 %), a toxidrome (21.3 %), or a major vital sign abnormality (17.3 %). The results of this study demonstrate that a wide variety of poisoned patients have been cared for in an observation unit in consultation with a boardcertified medical toxicologist. Patterns for the reasons for exposure, agents responsible for the exposure, and toxicological treatments will continue to evolve. Further study is needed to identify better those poisoned patients who can be appropriately managed in an observation unit.

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Principles of Observation Medicine

Cited by 43 publications

References 38 publications

The Pediatric Hybrid Observation Unit: An Analysis of 6477 Consecutive Patient Encounters

The Pediatric Hybrid Observation Unit: An Analysis of 6477 Consecutive Patient Encounters

Failure of Emergency Department Observation Unit Treatment for Skin and Soft Tissue Infections

Utilization of Observation Units for the Care of Poisoned Patients: Trends from the Toxicology Investigators Consortium Case Registry

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