The observation-holding area; a prospective study

Although emergency department observation-holding units have been shown to be effective in limiting hospitalizations and improving the accuracy of disposition, the possibility of adverse outcome following discharge from such units has not been addressed. To establish the safety of the unit, a five-month prospective study of all patients admitted to this area was carried out and included long-term follow-up. There were 442 patients admitted. Of these, 78% were discharged improved. Complications in the unit were minimal and there were no deaths. Long-term follow-up revealed four deaths (1%) and four patients (1%) who had complicated hospitalizations. Diagnosis, age, patient condition, and time of admission to the unit were predictive of the need for inpatient hospitalization. We conclude that the observation-holding unit, with appropriate supervision, represents a safe alternative disposition for selected emergency patients.