Journal review

Martinez E, Reilly BM, Evans AT, et al. The observation unit: A new interface between inpatient and outpatient care. Am J Med 2001; 110:274-277.

Use of ED observation units can reduce inpatient admissions, says this study from Cook County Hospital and Rush Medical College, both based in Chicago. A 12-bed ED observation unit was studied for three years, and 85% (6,334) of the admitted patients were discharged home within 23 hours. The total number of patients admitted decreased significantly, with 5,366 fewer patients admitted during the three years of operation, compared with the three previous years. The researchers recommend the following:

  • developing and implementing streamlined diagnostic and treatment protocols;
  • studying patterns of care and outcomes for patients treated in observation units;
  • developing clinical prediction rules and evidence-based guidelines.

The researchers acknowledge that they can’t be sure that all the observation-unit patients would have been hospitalized. However, they note that analysis of trends in the Chicago area supports the finding that observation units contributed to a reduction in hospital admissions.

"Observation units can serve patients with diverse clinical syndromes and may reduce inpatient admissions," they conclude. (For more information about using observation units, see ED Management, May 2001, p. 49, and EDM, June 2001, p. 64.)