[The observation unit and patients with chest pain--an efficient organizational model?]

Patients with chest pain make up 5-8% of all acute admissions to a department of internal medicine. Many of these patients could be discharged safely after a limited period of observation. Aker University Hospital opened an observation unit in the autumn of 2000, but for organizational reasons closed the ward on weekends for 4 months in the autumn of 2001.

This study assessed the effect of this observation unit on the average admission time (in days) for patients who presented with chest pain. This was a retrospective cohort study which compared the average admission time for patients admitted on Fridays and Saturdays in the autumn of 2001 (n = 75), compared with those admitted in the autumn of 2000 and 2002 (n = 100).

The two groups are directly comparable with regards to age, gender, general risk factors, pre-morbid hospitalization and co-morbidity. The average hospital stay was 3.84 days when the unit was closed, as opposed to 2.59 days when it was in operation. Corrected for age and previous cardiac illness, the closing of the observation ward led to an increase in hospital stay by 1.11 days, p = 0,001. This corresponded to an increase in average admission time of 43%. Most of this difference was accounted for by a higher discharge rate within 24 hours when the unit was in operation. There was no increase in the number of readmissions within 30 days.

The observation unit leads to a meaningful shortening of admission time for patients with chest pain. This has not previously been shown in a Norwegian hospital.