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The Impact of Leveraging an Emergency Department Observation Unit for Pandemic Response on Observation Outcomes: A
Michael J Carr1, Iyesatta M Emeli1, Douglas W Chesson1
1Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Journal of the American College of Emergency Physicians Open
|August 4, 2026
Summary
Shifting observation patients from emergency department observation units (EDOU) to inpatient beds during a public health emergency increased costs, length of stay (LOS), and admission rates. This strategy negatively impacted hospital observation outcomes.
Area of Science:
- Health Services Research
- Hospital Administration
- Emergency Medicine
Background:
- Emergency department observation units (EDOU) are critical for managing patients requiring short-term monitoring.
- The utility of EDOUs for alternative purposes during public health emergencies remains understudied.
- Understanding the impact of EDOU repurposing is essential for maintaining optimal hospital operations during crises.
Purpose of the Study:
- To determine the impact of relocating observation patients from EDOUs to inpatient beds on key hospital observation outcomes.
- To analyze changes in length of stay (LOS), total cost, and inpatient admission rates following EDOU repurposing.
- To evaluate the consequences of utilizing EDOUs for alternative functions during a public health emergency.
Main Methods:
- A retrospective observational difference-in-differences study was conducted across four hospitals in Atlanta, Georgia.
- One hospital converted its EDOU to a COVID unit, displacing observation patients to inpatient beds, serving as the intervention group.
- Three hospitals served as controls, maintaining standard EDOU operations; data were compared pre- and post-intervention using mixed-effects regressions.
Main Results:
- The intervention hospital experienced a 35% increase in total cost (MR=1.35) and a 22% increase in observation LOS (MR=1.22).
- Total LOS saw a non-significant increase (MR=1.14) in the intervention hospital, while control hospitals showed a significant decrease.
- Inpatient admission rates significantly increased by 74% (OR=1.74) in the intervention hospital compared to stable rates in control hospitals.
Conclusions:
- Repurposing EDOUs by displacing observation patients to inpatient beds during public health emergencies is associated with significant negative impacts.
- Observed increases in cost, LOS, and admission rates highlight the detrimental effects on standard observation care.
- Healthcare systems must carefully consider the downstream consequences before altering EDOU operational status during surge events.
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