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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Saturday, November 12, 2011

Observation Units

State of the Art: Observation Units in
the Emergency Department
Policy Resourde and Education Paper
Hospitals and emergency departments (EDs) face the challenges of escalating health care costs, mismatched resource utilization, concern over avoidable admissions, as well as hospital and ED overcrowding. One approach that has been used by hospitals to address these issues is the use of emergency department observation units (EDOU). Observation of patients following their initial ED visit has been described for over three decades, beginning shortly after the formal development of EDs in the 1960s.1 Research in this setting has increased in recent years, leading to a better understanding the role of these units and their unique benefits.
A 2003 national survey estimated that ED observation units are present in 19% of U.S. hospitals, with 12% planning a unit.
A subsequent analysis of 2007 National Hospital Ambulatory Medical Care Survey data indicated that the percent of U.S. hospitals with an EDOU had increased to 36%, with more than half administratively managed by the ED.3 Among academic centers with an Emergency Medicine residency program, 36% report having an EDOU, with another 45% planning a unit.4 Internationally, emergency observation services have been reported in several countries, including Canada, Britain, throughout Europe, Australia, India, China, Singapore and South America.5-12 In its discussion of "improving the efficiency of hospital-based emergency care," the 2006 Institute of Medicine report supports the use of the EDOU as a means of decreasing ED boarding, ambulance diversion, and avoidable hospitalizations.13 From 2003 to 2007, the percentage of Medicare patients whose observation stays exceeds 48 hours has risen from 3% to over 7%, suggesting that care in a more efficient setting may be needed. With the expansion of information in this area and pressing health care issues, a more contemporary review of observation services is needed.