The Case for Observation Medicine Education and Training in Emergency Medicine

Abstract

Background: Many hospitals have or will be opening an observation unit (OU), the majority managed by the emergency department (ED). Graduating emergency medicine (EM) residents will be expected to have the knowledge and skills necessary to appropriately identify and manage patients in this setting. Our objective is to examine the current state of observation medicine (OM) education and prevalence in EM training. Methods:In a follow-up to the 2019 Society for Academic Emergency Medicine (SAEM) OM Interest Group meeting, we convened an expert panel of OM physicians who are members of both the SAEM OM Interest Group and the American College of Emergency Physicians Section of OM. The panel of six emergency physicians representing geographic diversity was formed. A structured literature review was performed yielding 16 educational publications and sources pertaining to OM education and training across all specialties.Report on the Existing Literature: Only a small number of EM residencies have a required or elective OM rotation in an OU. An OM rotation in a protocol-driven ED OU gives residents experience managing patients in this setting and improves skills integral to EM and part of the EM milestones and Accreditation Council for Graduate Medical Education (ACGME) core competencies: reassessment, disposition decision making, risk stratification, team management, and practicing cost-appropriate care. Even without a formal rotation, multiple OM educational resources can be incorporated into EM resident education and didactics. Education research opportunity exists. Conclusions: This panel believes that OM is an important component of EM that should be incorporated into EMresidency as the knowledge and skills learned such as risk stratification, disposition decision making, and team management augment those needed for the practice of EM. There is a distinct opportunity for EM educators to better equip their trainees for a career in EM by including OM education and experience in EM residency training.From the

Tertiary Trauma Survey on Emergency Department Observational Units: A Systematic Literature Review

“…Observational medicine (OM) is an integral part of emergency medicine (EM), and according to Lily et al 1985, approximately 2.5% of trauma patients are admitted to the emergency department observational units (EDOU) [ 6 , 7 ]. The general purpose of EDOU, also known as clinical decision unit (CDU), short-stay unit (SSU), or emergency observation unit (EOU), is a short-term admission of patients for 24-hour observation and monitoring, and to ensure any essential urgent investigations or reviews [ 6 , 7 ]. This ensures adequate monitoring, comprehensive re-assessment, and safe discharge from the ED while avoiding unnecessary in-hospital admissions.…”

“…This ensures adequate monitoring, comprehensive re-assessment, and safe discharge from the ED while avoiding unnecessary in-hospital admissions. With respect to trauma patients, an EDOU plays an important role as a vast number of trauma patients do not need formal admission but benefit from a short EDOU admission [ 7 ]. These patients form a substantial subset of poly-trauma patients with low-to-moderate risk trauma, in whom it would be prudent to perform a comprehensive re-assessment prior to discharge to identify type I missed injuries.…”

Impact of an Observation Medicine Educational Intervention on Residents’ Confidence, Knowledge, and Attitudes: A Quasi-Experimental Study

“…2 Observation medicine (OM), therefore, encompasses the knowledge and skill needed to observe selected patients and actively manage them beyond the emergency department (ED), typically up to 24 hours. 3,4 The emergence of OM as a medical specialty parallels the growth of emergency medicine (EM). 5,6 The American College of Emergency Physicians, in its policy statement, reported that "observation of appropriate ED patients in a dedicated ED observation area, instead of a general inpatient bed or an acute care ED bed, is a 'best practice' that requires commitment of staff and hospital resources."…”

“…The Centers for Medicare and Medicaid Services defines observation care as “a specific, well-defined set of clinically appropriate services, which include ongoing assessment, reassessment, and short-term treatment; before a decision regarding further inpatient hospital management or discharge can be finalized.” 2 Observation medicine (OM), therefore, encompasses the knowledge and skill needed to observe selected patients and actively manage them beyond the emergency department (ED), typically up to 24 hours. 3 , 4 …”

The Utilization of 15-Minute Multidisciplinary Rounds to Reduce Length of Stay in Patients under Observation Status

“…Observation care, as defined by the Centers for Medicare and Medicaid Services (CMS), encompasses specific, clinically appropriate services that involve short-term treatment, assessment, and reassessment to determine the need for further hospital inpatient treatment or discharge [1][2][3][4][5]. Typically, patients placed under observation status stay for approximately 24 to 48 h [6][7][8].…”