Beyond observation: Protocols and capabilities of an Emergency Department Observation Unit

Area of Science:

• Emergency Medicine
• Healthcare Management

Background:

• Emergency Department Observation Units (Obs Units) offer a critical setting for ongoing patient care post-emergency department (ED) evaluation.
• A complex, protocol-driven 20-bed Obs Unit utilizes 36 distinct protocols to manage patient flow and treatment.

Purpose of the Study:

• To evaluate the performance of different protocols within an ED observation unit.
• To identify the types of care, including consultations and procedures, provided in the Obs Unit.

Main Methods:

• A retrospective chart review of 10% of ED patient charts with an observation order was conducted over 20 months (October 2015 - June 2017).
• Protocols were assessed based on length of stay (LOS) and admission rates to identify high and low functioning protocols.

Main Results:

• The study included 984 patients, with an average age of 49.5 years and 57.3% females. The admission rate was 23.5% with an average LOS of 13.7 hours.
• Chest pain and general protocols were most common (13.9% and 13.2%). Nearly 70% of patients received consultations, and 7.2% underwent procedures like lumbar punctures and endoscopies.

Conclusions:

• Observation Units are versatile, capable of managing a wide spectrum of patients requiring complex care, including consultations and procedures.
• These units effectively coordinate care while maintaining acceptable lengths of stay and admission rates, demonstrating their value in the healthcare system.