[Observational units--same good service to lower costs?]

With increased demand for hospital services and limited resources in the health sector, modes of organisation of services which give the same health outcome, but at lower cost, are of interest. Observation units in hospitals imply rapid diagnostic procedures and/or brief, but adequate treatment. We looked at the evidence for whether stays in observational units provide similar health outcome and reduce the admissions costs for hospitals compared to standard inpatient stays.

We systematically evaluated four randomized controlled studies that have compared the outcome for chest pain and asthma patients admitted to either observational units or directly to ordinary hospital units. The outcomes in focus were health effects measured as mortality and/or complications, length of stay and direct hospital costs.

The studies indicate that for the conditions included, there are no health outcome differences between patients treated in observational units on one hand or in ordinary hospital units on the other. Stays in observational units do not seem to imply increased risk of complication. Furthermore, the studies show a reduction in length of stay and hospital costs associated with the use of observational units.

The main reason for the reduction in length of stay and cost is quicker diagnosis in observational units than in the ordinary hospital units. The preconditions for these results are clear by defined criteria for selection of patients to the different units and well-defined protocols for making diagnoses and treating patients. If many patients after staying in observational units are transferred to ordinary hospital units or are discharged and then readmitted, the economic benefits of observational units could be undermined.