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National Study of Emergency Department Observation Services
Author(s) -
Wiler Jennifer L.,
Ross Michael A.,
Ginde Adit A.
Publication year - 2011
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.2011.01151.x
Subject(s) - medicine , emergency department , interquartile range , triage , ambulatory , emergency medicine , hospital admission , observational study , pediatrics , medical emergency , psychiatry , surgery , pathology
ACADEMIC EMERGENCY MEDICINE 2011; 18:959–965 © 2011 by the Society for Academic Emergency Medicine Abstract Objectives: The objective was to describe patient and facility characteristics of emergency department (ED) observation services in the United States. Methods: The authors analyzed the 2007 National Hospital Ambulatory Medical Care Survey (NHAMCS). Characteristics of EDs with observation units (OUs) were compared to those without, and patients with a disposition of ED observation were compared to those with a “short‐stay” (<48 hour) hospital admission. Results are descriptive and without formal statistical comparisons for this observational analysis. Results: An estimated 1,746 U.S. EDs (36%) reported having OUs, of which 56% are administratively managed by ED staff. Fifty‐two percent of hospitals with ED‐managed OUs are in an urban location, and 89% report ED boarding, compared to 29 and 65% of those that do not have an OU. The admission rate is 38% at those with ED‐managed OUs and 15% at those without OUs. Of the 15.1% of all ED patients who are kept in the hospital following an ED visit, one‐quarter are kept for either a short‐stay admission (1.8%) or an ED observation admission (2.1%). Most (82%) ED observation patients were discharged from the ED. ED observation patients were similar to short‐stay admission patients in terms of age (median = 52 years for both, interquartile range = 36 to 70 years), self‐pay (12% vs. 10%), ambulance arrival (37% vs. 36%), urgent/emergent triage acuity (77% vs. 74%), use of ≥1 ED medication (64% vs.76%), and the most common primary chief complaints and primary diagnoses. Conclusions: Over one‐third of U.S. EDs have an OU. Short‐stay admission patients have similar characteristics as ED observation patients and may represent an opportunity for the growth of OUs.