Skip to main content Accessibility help
×
Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-17T14:45:28.808Z Has data issue: false hasContentIssue false

Part VII - Evidence Basis for Observation Medicine

Published online by Cambridge University Press:  31 March 2017

Sharon E. Mace
Affiliation:
Department of Emergency Medicine, Cleveland Clinic, Ohio
Get access

Summary

Abstract

This chapter deals with critical issues in observation medicine for adult patients based on a given diagnosis or clinical condition, such as chest pain or asthma. A separate chapter deals with critical issues in observation medicine based on age, for example, observation medicine for pediatric and geriatric patients. The critical questions addressed in this chapter are:

  1. 1: In adult patients, when compared with inpatient treatment does the provision of observation services, specifically in a dedicated, protocol-driven observation unit (OU), improve patient outcomes, decrease length of stay (LOS), reduce costs, increase patient satisfaction, and have other benefits, including (but not limited to) decreased readmissions?

  2. 2: In adult patients, does the use of OU clinical and administrative methodology (by aggressive early diagnostic and therapeutic management using tools such as protocol-driven therapy) produce equivalent or better results (e.g., patient outcomes, LOS, costs, and adverse events) compared with routine inpatient care?

  3. 3: In the adult emergency department (ED), does use of an OU improve key measures of department efficiency, such as decreases in ED LOS, door-to-doctor time, ambulance diversion, and the left-without-being-seen rate?

Type
Chapter
Information
Observation Medicine
Principles and Protocols
, pp. 429 - 508
Publisher: Cambridge University Press
Print publication year: 2017

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

References

Baugh, CW, Venkatesh, AK, Hilton, JA, et al. Making greater use Of dedicated hospital observation units for many short-stay patients could save $3.1 billion a year. Health Aff 2012;31(10):23142323.CrossRefGoogle ScholarPubMed
de Leon, AC Jr, Farmer, CA, King, G, et al. Chest pain evaluation unit: a cost-effective approach for ruling out acute myocardial infarction. South Med J 1989 Sep;82(9):10831089.CrossRefGoogle ScholarPubMed
Gibler, WB, Young, GP, Hedges, JR, et al. Acute myocardial infarction in chest pain patients with nondiagnostic ECGs: serial CK-MB sampling in the emergency department. The Emergency Medicine Cardiac Research Group. Ann Emerg Med 1992 May;21(5):504512.CrossRefGoogle ScholarPubMed
Gaspoz, JM, Lee, TH, Weinstein, MC, et al. Cost-effectiveness of a new short-stay unit to “rule out” acute myocardial infarction in low risk patients. J Am Coll Cardiol 1994 Nov 1;24(5):12491259.CrossRefGoogle ScholarPubMed
Gomez, MA, Anderson, JL, Karagounis, LA, et al. An emergency department-based protocol for rapidly ruling out myocardial ischemia reduces hospital time and expense: results of a randomized study (ROMIO). J Am Coll Cardiol 1996 Jul;28(1):2533.CrossRefGoogle ScholarPubMed
Roberts, RR, Zalenski, RJ, Mensah, EK, et al. Costs of an emergency department-based accelerated diagnostic protocol vs hospitalization in patients with chest pain: a randomized controlled trial. JAMA 1997 Nov 26;278(20):16701676.CrossRefGoogle ScholarPubMed
Rydman, RJ, Zalenski, RJ, Roberts, RR, et al. Patient satisfaction with an emergency department chest pain observation unit. Ann Emerg Med 1997 Jan;29(1):109115.CrossRefGoogle ScholarPubMed
Zalenski, RJ, Rydman, RJ, McCarren, M, et al. Feasibility of a rapid diagnostic protocol for an emergency department chest pain unit. Ann Emerg Med 1997 Jan;29(1):99108.CrossRefGoogle ScholarPubMed
Farkouh, ME, Smars, PA, Reeder, GS, et al. A clinical trial of a chest-pain observation unit for patients with unstable angina. Chest Pain Evaluation in the Emergency Room (CHEER) Investigators. N Engl J Med 1998 Dec 24;339(26):18821888.CrossRefGoogle ScholarPubMed
Goodacre, S, Nicholl, J, Dixon, S, et al. Randomised controlled trial and economic evaluation of a chest pain observation unit compared with routine care. BMJ 2004 Jan 31;328(7434):254.CrossRefGoogle ScholarPubMed
Goodacre, S, Nicholl, J. A randomised controlled trial to measure the effect of chest pain unit care upon anxiety, depression, and health-related quality of life [ISRCTN85078221. Health Qual Life Outcomes 2004 Jul 29;2:39.CrossRefGoogle ScholarPubMed
Miller, CD, Hwang, W, Hoekstra, JW, et al. Stress cardiac magnetic resonance imaging with observation unit care reduces cost for patients with emergent chest pain: a randomized trial. Ann Emerg Med 2010 Sep;56(3):209–219.e2.CrossRefGoogle ScholarPubMed
Kerns, JR, Shaub, TF, Fontanarosa, PB. Emergency cardiac stress testing in the evaluation of emergency department patients with atypical chest pain. Ann Emerg Med 1993 May;22(5):794798.CrossRefGoogle ScholarPubMed
Sayre, MR, Bender, AL, Dey, CC, et al. Evaluating chest pain patients in an emergency department rapid diagnostic and treatment center is cost-effective. Academic Emergency Medicine 1994;1:A45.Google Scholar
Graff, LG, Dallara, J, Ross, MA, et al. Impact on the care of the emergency department chest pain patient from the chest pain evaluation registry (CHEPER) study. Am J Cardiol 1997 Sep 1;80(5):563568.CrossRefGoogle ScholarPubMed
Mikhail, MG, Smith, FA, Gray, M, et al. Cost-effectiveness of mandatory stress testing in chest pain center patients. Ann Emerg Med 1997 Jan;29(1):8898.CrossRefGoogle ScholarPubMed
Zalenski, RJ, McCarren, M, Roberts, R, et al. An evaluation of a chest pain diagnostic protocol to exclude acute cardiac ischemia in the emergency department. Archives of Internal Medicine 1997;157(10):10851091.CrossRefGoogle ScholarPubMed
Stomel, R, Grant, R, Eagle, KA. Lessons learned from a community hospital chest pain center. Am J Cardiol 1999 Apr 1;83(7):10331037.CrossRefGoogle ScholarPubMed
Lai, C, Noeller, TP, Schmidt, K, et al. Short-term risk after initial observation for chest pain. J Emerg Med 2003 Nov;25(4):357362.CrossRefGoogle ScholarPubMed
Jagminas, L, Partridge, R. A comparison of emergency department versus inhospital chest pain observation units. Am J Emerg Med 2005 Mar;23(2):111113.CrossRefGoogle ScholarPubMed
Diercks, DB, Kirk, JD, Turnipseed, SD, et al. Evaluation of patients with methamphetamine- and cocaine-related chest pain in a chest pain observation unit. Crit pathw cardiol 2007 Dec;6(4):161164.CrossRefGoogle Scholar
Chang, AM, Shofer, FS, Weiner, MG, et al. Actual financial comparison of four strategies to evaluate patients with potential acute coronary syndromes. Acad Emerg Med 2008 Jul;15(7):649655.CrossRefGoogle ScholarPubMed
Limkakeng, AT Jr, Chandra, A. Impact of renal dysfunction on acute coronary syndrome evaluation in observation unit patients. Am J Emerg Med 2010 Jul;28(6):658662.CrossRefGoogle ScholarPubMed
Maag, R, Krivenko, C, Graff, L, et al. Improving chest pain evaluation within a multihospital network by the use of emergency department observation units. Jt Comm J Qual Improv 1997 Jun;23(6):312320.Google ScholarPubMed
Kirk, JD, Turnipseed, S, Lewis, WR, et al. Evaluation of chest pain in low-risk patients presenting to the emergency department: the role of immediate exercise testing. Ann Emerg Med 1998 Jul;32(1):17.CrossRefGoogle Scholar
Goodacre, S, Mason, S, Arnold, J, et al. Psychologic morbidity and health-related quality of life of patients assessed in a chest pain observation unit. Ann Emerg Med 2001 Oct;38(4):369376.CrossRefGoogle Scholar
Weber, JE, Shofer, FS, Larkin, GL, et al. Validation of a brief observation period for patients with cocaine-associated chest pain. N Engl J Med 2003 Feb 6;348(6):510517.CrossRefGoogle ScholarPubMed
Goodacre, S, Dixon, S. Is a chest pain observation unit likely to be cost effective at my hospital? Extrapolation of data from a randomised controlled trial. Emerg Med J 2005 Jun;22(6):418422.CrossRefGoogle ScholarPubMed
Madsen, T, Mallin, M, Bledsoe, J, et al. Utility of the emergency department observation unit in ensuring stress testing in low-risk chest pain patients. Crit Pathw Cardiol 2009 Sep;8(3):122124.CrossRefGoogle ScholarPubMed
Madsen, T, Bossart, P, Bledsoe, J, et al. Patients with coronary disease fail observation status at higher rates than patients without coronary disease. Am J Emerg Med 2010 Jan;28(1):1922.CrossRefGoogle ScholarPubMed
Pines, JM, Isserman, JA, Szyld, D, et al. The effect of physician risk tolerance and the presence of an observation unit on decision making for ED patients with chest pain. Am J Emerg Med 2010 Sep;28(7):771779.CrossRefGoogle ScholarPubMed
McDermott, M F, Murphy, D G, Zalenski, R J, et al. A comparison between emergency diagnostic and treatment unit and inpatient care in the management of acute asthma. Archives of Internal Medicine 1997;157(18):20552062.CrossRefGoogle ScholarPubMed
Rydman, RJ, Isola, ML, Roberts, RR, et al. Emergency department observation unit versus hospital inpatient care for a chronic asthmatic population: a randomized trial of health status outcome and cost. Med Care 1998 Apr;36(4):599609.CrossRefGoogle ScholarPubMed
Rydman, RJ, Roberts, RR, Albrecht, GL, et al. Patient satisfaction with an emergency department asthma observation unit. Acad Emerg Med 1999 Mar;6(3):178183.CrossRefGoogle ScholarPubMed
Zwicke, DL, Donohue, JF, Wagner, EH. Use of the emergency department observation unit in the treatment of acute asthma. Ann Emerg Med 1982 Feb;11(2):7783.CrossRefGoogle ScholarPubMed
Brillman, JC, Tandberg, D. Observation unit impact on ED admission for asthma. The American Journal of Emergency Medicine 1994;12(1).CrossRefGoogle ScholarPubMed
Mace, SE. Asthma therapy in the observation unit. Emerg Med Clin North Am 2001 Feb;19(1):169185.CrossRefGoogle ScholarPubMed
Shen, WK, Decker, WW, Smars, PA, et al. Syncope Evaluation in the Emergency Department Study (SEEDS): a multidisciplinary approach to syncope management. Circulation 2004 Dec 14;110(24):36363645.CrossRefGoogle Scholar
Stockley, CJ, Bonney, ME, Gray, AJ, et al. Syncope management in the UK and Republic of Ireland. Emerg Med J 2009 May;26(5):331333.CrossRefGoogle ScholarPubMed
Ross, MA, Compton, S, Medado, P, et al. An emergency department diagnostic protocol for patients with transient ischemic attack: a randomized controlled trial. Ann Emerg Med 2007 Aug;50(2):109119.CrossRefGoogle ScholarPubMed
Brown, MD, Reeves, MJ, Glynn, T, et al. Implementation of an emergency department based transient ischemic attack clinical pathway: a pilot study in knowledge translation. Acad Emerg Med 2007 Nov;14(11):11141119.Google ScholarPubMed
Rothwell, PM, Giles, MF, Chandratheva, A, et al. Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison. Lancet 2007 Oct 20;370(9596):14321442.CrossRefGoogle ScholarPubMed
Luengo-Fernandez, R, Gray, AM, Rothwell, PM. Effect of urgent treatment for transient ischaemic attack and minor stroke on disability and hospital costs (EXPRESS study): a prospective population-based sequential comparison. Lancet Neurol 2009 Mar;8(3):235243.CrossRefGoogle ScholarPubMed
Lavallee, PC, Meseguer, E, Abboud, H, et al. A transient ischaemic attack clinic with round-the-clock access (SOS-TIA): feasibility and effects. Lancet Neurol 2007 Nov;6(11):953960.CrossRefGoogle ScholarPubMed
Stead, LG, Bellolio, MF, Suravaram, S, et al. Evaluation of transient ischemic attack in an emergency department observation unit. Neurocrit Care 2009;10(2):204208.CrossRefGoogle Scholar
Koopman, MMW, Prandoni, P, Piovella, F, et al. Treatment of venous thrombosis with intravenous unfractionated heparin administered in the hospital as compared with subcutaneous low-molecular-weight heparin administered at home. N Engl J Med 1996 03/14; 2013/02;334(11):682687.CrossRefGoogle Scholar
Levine, M, Gent, M, Hirsh, J, et al. A comparison of low-molecular-weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal deep-vein thrombosis. N Engl J Med 1996 Mar 14;334(11):677681.CrossRefGoogle ScholarPubMed
O’Brien, B, Levine, M, Willan, A, et al. Economic evaluation of outpatient treatment with low-molecular-weight heparin for proximal vein thrombosis. Arch Intern Med 1999 Oct 25;159(19):22982304.Google ScholarPubMed
Vinson, DR, Berman, DA. Outpatient treatment of deep venous thrombosis: a clinical care pathway managed by the emergency department. Ann Emerg Med 2001 Mar;37(3):251258.CrossRefGoogle ScholarPubMed
Rodger, M, Bredeson, C, Wells, PS, et al. Cost-effectiveness of low-molecular-weight heparin and unfractionated heparin in treatment of deep vein thrombosis. CMAJ 1998 Oct 20;159(8):931938.Google ScholarPubMed
Gould, MK, Dembitzer, AD, Sanders, GD, et al. Low-molecular-weight heparins compared with unfractionated heparin for treatment of acute deep venous thrombosis. A cost-effectiveness analysis. Ann Intern Med 1999 May 18;130(10):789799.CrossRefGoogle ScholarPubMed
Decker, WW, Smars, PA, Vaidyanathan, L, et al. A prospective, randomized trial of an emergency department observation unit for acute onset atrial fibrillation. Annals of Emergency Medicine 2008;52(4):322328.CrossRefGoogle ScholarPubMed
Cristoni, L, Tampieri, A, Mucci, F, et al. Cardioversion of acute atrial fibrillation in the short observation unit: comparison of a protocol focused on electrical cardioversion with simple antiarrhythmic treatment. Emerg Med J 2011 Nov;28(11):932937.CrossRefGoogle ScholarPubMed
Kim, MH, Morady, F, Conlon, B, et al. A prospective, randomized, controlled trial of an emergency department-based atrial fibrillation treatment strategy with low-molecular-weight heparin. Ann Emerg Med 2002 Aug;40(2):187192.CrossRefGoogle ScholarPubMed
Conti, A, Canuti, E, Mariannini, Y, et al. Clinical management of atrial fibrillation: early interventions, observation, and structured follow-up reduce hospitalizations. Am J Emerg Med 2012 Nov;30(9):19621969.CrossRefGoogle ScholarPubMed
Koenig, BO, Ross, MA, Jackson, RE. An emergency department observation unit protocol for acute-onset atrial fibrillation is feasible. Ann Emerg Med 2002 Apr;39(4):374381.CrossRefGoogle ScholarPubMed
Ross, MA, Davis, B, Dresselhouse, A. The role of an emergency department observation unit in a clinical pathway for atrial fibrillation. Crit Pathw Cardiol 2004 Mar;3(1):812.CrossRefGoogle Scholar
Stiell, IG, Clement, CM, Perry, JJ, et al. Association of the Ottawa Aggressive Protocol with rapid discharge of emergency department patients with recent-onset atrial fibrillation or flutter. CJEM 2010 May;12(3):181191.CrossRefGoogle ScholarPubMed
Vinson, DR, Hoehn, T, Graber, DJ, et al. Managing emergency department patients with recent-onset atrial fibrillation. J Emerg Med 2012 Feb;42(2):139148.CrossRefGoogle ScholarPubMed
Lopez, PP, Cohn, SM, Popkin, CA, et al. Appendicitis Diagnostic G. The use of a computed tomography scan to rule out appendicitis in women of childbearing age is as accurate as clinical examination: a prospective randomized trial. Am Surg 2007 Dec;73(12):12321236.CrossRefGoogle Scholar
White, JJ, Santillana, M, Haller, JA Jr. Intensive in-hospital observation: a safe way to decrease unnecessary appendectomy. Am Surg 1975 Dec;41(12):793798.Google ScholarPubMed
Graff, L, Radford, MJ, Werne, C. Probability of appendicitis before and after observation. Ann Emerg Med 1991 May;20(5):503507.CrossRefGoogle ScholarPubMed
Graff, L, Russell, J, Seashore, J, et al. False-negative and false-positive errors in abdominal pain evaluation: failure to diagnose acute appendicitis and unnecessary surgery. Acad Emerg Med 2000 Nov;7(11):12441255.CrossRefGoogle ScholarPubMed
Thomson, HJ, Jones, PF. Active observation in acute abdominal pain. Am J Surg 1986 Nov;152(5):522525.CrossRefGoogle ScholarPubMed
Saunders, CE, Gentile, DA. Treatment of mild exacerbations of recurrent alcoholic pancreatitis in an emergency department observation unit. South Med J 1988 Mar;81(3):317320.CrossRefGoogle Scholar
Fabbri, A, Servadei, F, Marchesini, G, et al. Which type of observation for patients with high-risk mild head injury and negative computed tomography?. Eur J Emerg Med 2004 Apr;11(2):6569.CrossRefGoogle ScholarPubMed
af Geijerstam, JL, Oredsson, S, Britton, M, OCTOPUS Study I. Medical outcome after immediate computed tomography or admission for observation in patients with mild head injury: randomised controlled trial. BMJ 2006 Sep 2;333(7566):465.CrossRefGoogle ScholarPubMed
Norlund, A, Marke, LA, af Geijerstam, JL, et al. Immediate computed tomography or admission for observation after mild head injury: cost comparison in randomised controlled trial. BMJ 2006 Sep 2;333(7566):469.CrossRefGoogle ScholarPubMed
Menditto, VG, Lucci, M, Polonara, S, et al. Management of minor head injury in patients receiving oral anticoagulant therapy: a prospective study of a 24-hour observation protocol. Ann Emerg Med 2012 Jun;59(6):451455.CrossRefGoogle ScholarPubMed
MacLaren, RE, Ghoorahoo, HI, Kirby, NG. Use of an accident and emergency department observation ward in the management of head injury. Br J Surg 1993 Feb;80(2):215217.CrossRefGoogle ScholarPubMed
Af Geijerstam, JL, Britton, M, Marke, LA. Mild head injury: observation or computed tomography? Economic aspects by literature review and decision analysis. Emerg Med J 2004 Jan;21(1):5458.CrossRefGoogle ScholarPubMed
Peacock, WF 4th, Holland, R, Gyarmathy, R, et al. Observation unit treatment of heart failure with nesiritide: results from the proaction trial. J Emerg Med 2005 Oct;29(3):243252.CrossRefGoogle ScholarPubMed
Graff, L, Orledge, J, Radford, MJ, et al. Correlation of the Agency for Health Care Policy and Research congestive heart failure admission guideline with mortality: peer review organization voluntary hospital association initiative to decrease events (PROVIDE) for congestive heart failure. Ann Emerg Med 1999 Oct;34(4 Pt 1):429437.CrossRefGoogle ScholarPubMed
Storrow, AB, Collins, SP, Lyons, MS, et al. Emergency department observation of heart failure: preliminary analysis of safety and cost. Congest Heart Fail 2005 Mar–Apr;11(2):6872.CrossRefGoogle ScholarPubMed
Peacock, WF 4th, Remer, EE, Aponte, J, et al. Effective observation unit treatment of decompensated heart failure. Congest Heart Fail 2002 Mar–Apr;8(2):6873.CrossRefGoogle ScholarPubMed
Burkhardt, J, Peacock, WF, Emerman, CL. Predictors of emergency department observation unit outcomes. Acad Emerg Med 2005 Sep;12(9):869874.CrossRefGoogle ScholarPubMed
Diercks, DB, Peacock, WF, Kirk, JD, et al. ED patients with heart failure: identification of an observational unit-appropriate cohort. Am J Emerg Med 2006 May;24(3):319324.CrossRefGoogle ScholarPubMed
Collins, SP, Schauer, DP, Gupta, A, et al. Cost-effectiveness analysis of ED decision making in patients with non-high-risk heart failure. Am J Emerg Med 2009 Mar;27(3):293302.CrossRefGoogle ScholarPubMed
Schrock, JW, Reznikova, S, Weller, S. The effect of an observation unit on the rate of ED admission and discharge for pyelonephritis. Am J Emerg Med 2010 Jul;28(6):682688.CrossRefGoogle ScholarPubMed
Israel, RS, Lowenstein, SR, Marx, JA, et al. Management of acute pyelonephritis in an emergency department observation unit. Ann Emerg Med 1991 Mar;20(3):253257.CrossRefGoogle Scholar
Ward, G, Jorden, RC, Severance, HW. Treatment of pyelonephritis in an observation unit. Ann Emerg Med 1991 Mar;20(3):258261.CrossRefGoogle Scholar
Schrock, JW, Laskey, S, Cydulka, RK. Predicting observation unit treatment failures in patients with skin and soft tissue infections. Int J Emerg Med 2008 Jun;1(2):8590.CrossRefGoogle ScholarPubMed
Conrad, L, Markovchick, V, Mitchiner, J, et al. The role of an emergency department observation unit in the management of trauma patients. J Emerg Med 1985;2(5):325333.CrossRefGoogle ScholarPubMed
Henneman, PL, Marx, JA, Cantrill, SC, et al. The use of an emergency department observation unit in the management of abdominal trauma. Ann Emerg Med 1989 Jun;18(6):647650.CrossRefGoogle ScholarPubMed
Cowell, VL, Ciraulo, D, Gabram, S, et al. Trauma 24-hour observation critical path. J Trauma 1998 Jul;45(1):147150.CrossRefGoogle ScholarPubMed
Madsen, TE, Bledsoe, JR, Bossart, PJ. Observation unit admission as an alternative to inpatient admission for trauma activation patients. Emerg Med J 2009 Jun;26(6):421423.CrossRefGoogle ScholarPubMed
Foulke, GE. Identifying toxicity risk early after antidepressant overdose. Am J Emerg Med 1995 Mar;13(2):123126.CrossRefGoogle ScholarPubMed
Hollander, JE, McCracken, G, Johnson, S, et al. Emergency department observation of poisoned patients: how long is necessary? [see comment]. Acad Emerg Med 1999 Sep;6(9):887894.CrossRefGoogle ScholarPubMed
Sivilotti, ML, Yarema, MC, Juurlink, DN, et al. A risk quantification instrument for acute acetaminophen overdose patients treated with N-acetylcysteine. Ann Emerg Med 2005 Sep;46(3):263271.CrossRefGoogle ScholarPubMed
Sztajnkrycer, MD, Mell, HK, Melin, GJ. Development and implementation of an emergency department observation unit protocol for deliberate drug ingestion in adults - preliminary results. Clin Toxicol (Phila) 2007 Jun–Aug;45(5):499504.CrossRefGoogle ScholarPubMed
Chan, SS, Yuen, EH, Kew, J, et al. Community-acquired pneumonia–implementation of a prediction rule to guide selection of patients for outpatient treatment. Eur J Emerg Med 2001 Dec;8(4):279286.CrossRefGoogle ScholarPubMed
Salazar, A, Juan, A, Ballbe, R, et al. Emergency short-stay unit as an effective alternative to in-hospital admission for acute chronic obstructive pulmonary disease exacerbation. Am J Emerg Med 2007 May;25(4):486487.CrossRefGoogle ScholarPubMed
Hadden, DS, Dearden, CH, Rocke, LG. Short stay observation patients: general wards are inappropriate. J Accid Emerg Med 1996 May;13(3):163165.CrossRefGoogle ScholarPubMed
Baugh, CW, Bohan, JS. Estimating observation unit profitability with options modeling. Acad Emerg Med 2008;15(5):445452.CrossRefGoogle ScholarPubMed
Bazarian, JJ, Schneider, SM, Newman, VJ, et al. Do admitted patients held in the emergency department impact the throughput of treat-and-release patients? Acad Emerg Med 1996 Dec;3(12):11131118.CrossRefGoogle ScholarPubMed
Kelen, GD, Scheulen, JJ, Hill, PM. Effect of an emergency department (ED) managed acute care unit on ED overcrowding and emergency medical services diversion. Acad Emerg Med 2001 Nov;8(11):10951100.CrossRefGoogle ScholarPubMed
Chandra, A, Sieck, S, Hocker, M, et al. An observation unit may help improve an institution’s Press Ganey satisfaction score. Crit Pathw Cardiol 2011 Jun;10(2):104106.CrossRefGoogle ScholarPubMed
Benjamin, LJ, Swinson, GI, Nagel, RL. Sickle cell anemia day hospital: an approach for the management of uncomplicated painful crises. Blood 2000 Feb 15;95(4):11301136.CrossRefGoogle ScholarPubMed
Cooke, MW, Higgins, J, Kidd, P. Use of emergency observation and assessment wards: a systematic literature review. Emerg Med J 2003 Mar;20(2):138142.CrossRefGoogle ScholarPubMed
Daly, S, Campbell, DA, Cameron, PA. Short-stay units and observation medicine: a systematic review. Med J Aust 2003 Jun 2;178(11):559563.CrossRefGoogle ScholarPubMed
Tempel, R, Severance, HW. Proposing short-term observation units for the management of decompression illness. Undersea Hyperb Med 2006 Mar–Apr;33(2):8994.Google ScholarPubMed
Ross, MA, Aurora, T, Graff, L, et al. State of the art: emergency department observation units. Crit Pathw Cardiol 2012 Sep;11(3):128138.CrossRefGoogle ScholarPubMed

References

Rosenbaum, L. The whole ball game – overcoming the blind spots in health care reform. N Eng J Med 2013; 368(10):959962.CrossRefGoogle ScholarPubMed
Creditor, MC. Hazards of hospitalization of the elderly. Ann Intern Med 1993; 118:219223.CrossRefGoogle ScholarPubMed
Rothschild, JM, Bates, DW, Leape, LL. Preventable medical injuries in older patients. Arch Intern Med 2000; 160:27172728.CrossRefGoogle ScholarPubMed
Gill, TM, Allore, HG, Gahbauer, EA, et al. Change in disability after hospitalization or restricted activity in older persons. JAMA 2010; 304:19191928.CrossRefGoogle ScholarPubMed
Ross, MA, Aurora, T, Graff, L, et al. State of the art: emergency department observation units. Crit Pathways in Cardiol 2012; 11:128138.CrossRefGoogle ScholarPubMed
Woodhams, V, de Lusignan, S Mughal, S, et al. Triumph of hope over experience: learning from interventions to reduce avoidable hospital admissions identified through an academic health and social care network. BMC Health Services Research 2012; 12:253262.CrossRefGoogle ScholarPubMed
Institute of Medicine. IOM report: the future of emergency care in the United States health system. Acad Emerg Med 2006; 13:10811085.CrossRefGoogle Scholar
American College of Emergency Physicians Policy Statement.Emergency department observation services. Ann Emerg Med 2008; 51: 686.CrossRefGoogle Scholar
Baugh, CW, Venkatesh, AK, Hilton, JA, et al. Making greater use Of dedicated hospital observation units for many short-stay patients could save $3.1 billion a year. Health Aff 2012;31(10):23142323.CrossRefGoogle ScholarPubMed
Listernick, R, Zieseri, E, Davis, AT. Outpatient oral rehydration in the United States. AJDC 1986; 140:211215.Google ScholarPubMed
Adekunle-Ojo, AO, Smitherman, HF, Parker, R, et al. Managing well-appearing neonates with hyperbilirubinemia in the emergency observation unit. Pediatr Emerg Care 2010; 26: 343348.CrossRefGoogle Scholar
Bajaj, L, Roback, MG. Postreduction management of intussception in a children’s hospital emergency department 2003: Pediatrics 112(6): 13021307.CrossRefGoogle Scholar
Greenberg, RA, Dudley, NC, Rittichier, KK. A reduction in hospitalization, length of stay, and hospital charges for croup with the institution of a pediatric observation unit. Amer J Emerg Med 2006; 24:818821.CrossRefGoogle ScholarPubMed
Marks, MK, Lovejoy, FH, Rutherford, PA, et al. Impact of a short stay unit on asthma patients admitted to a tertiary pediatric hospital. Quality Management in Health Care 1997; 6(1): 1422.CrossRefGoogle Scholar
Willert, C, David, AT, Herman, JJ, et al. Short-term holding room treatment of asthmatics. J Pediatr 1985; 106: 707711.CrossRefGoogle Scholar
Browne, GJ. A short-stay or 23 hour ward in a general and academic childrens hospital: are they effective? Pediatric Emergency Care 2000; 16(4):223229.CrossRefGoogle ScholarPubMed
O’Brien, SR, Hein, EW, Sly, RM. Treatment of acute asthmatic attacks in a holding unit of a pediatric emergency room Annals of Allergy 1980; 45(3):1591162.Google Scholar
Gururaj, VJ, Allen, JE, Russo, RM. Short stay in an outpatient department: an alternative to hospitalization. Amer J Dis Childn 1972; 123:128133.CrossRefGoogle Scholar
Martineau, O, Martinot, A, Chatier, A, et al. Effectiveness of a short-stay observation unit in a pediatric emergency department. Archives de Pediatrie 2003; 10:410416.CrossRefGoogle Scholar
Gouin, S, Macarthur, C, Parkkin, PC, et al. Effect of pediatric observation unit on the rate of hospitalization for asthma. Ann Emerg Med 1997; 29(2): 218222.CrossRefGoogle ScholarPubMed
Lamireau, T, Lanas, B, Dommange, S, et al. A short-stay observation unit improves care in the paediatric emergency care setting. European J Emerg Med 2000; 7: 261265.CrossRefGoogle ScholarPubMed
Hostetler, B, Leikin, JB, Timmons, JA, et al. Patterns of use of an emergency department-based observation unit. Amer J Therapuetics 2002; 9:499502.CrossRefGoogle ScholarPubMed
Geelhoed, GC. Sixteen years of croup in a Western Australian teaching hospital: effects of routine steroid treatment. Ann Emerg Med 1996; 28(6):621626.CrossRefGoogle Scholar
Rentz, AC, Kadish, HA, Nelson, DS. Physician satisfaction with a pediatric observation unit administered by pediatric emergency medicine physicians. Pediatr Emerg Care 2004; 20(7):430432.CrossRefGoogle ScholarPubMed
Alpern, ER, Callello, DP, Windreich, R, et a Utilization and unexpected hospitalization rates of a pediatric emergency department 23 hour observation unit. Pediatr Emerg Care 2008; 24(9): 589594.CrossRefGoogle ScholarPubMed
Adekunle-Ojo, Craig AM, Long, Ma, et al. Intussusception: postreduction fasting is not necessary to prevent complications and recurrences in the emergency department observation unit. Pediatr Emerg Care 2011; 27(10):897899.CrossRefGoogle Scholar
Calello, DP, Alpern, ER, McDaniel Yakscoe, M, et al. Observation unit experience for pediatric poison exposures. J Medical Toxicology 2009: 5(1):1519.CrossRefGoogle ScholarPubMed
Crocetti, MT, Barone, MA, Dritt Amin, D, et al. Pediatric observation status beds on an inpatient unit : an integrated care model. Pediatr Emerg care 2004; 20(1):1721.CrossRefGoogle Scholar
Ellerstein, NS, Sullivan, TD. Observation unit in a children’s hospital: adjunct to delivery and teaching of ambulatory pediatric care. New York State Journal of Medicine 1980; 80(11):16841686.Google Scholar
Holsti, M, Kadish, HA, Sill, BL, et al. Pediatric closed head injuries treated in an observation unit. Pediatr Emerg Care 2005; 21(10):639644.CrossRefGoogle Scholar
LeDuc, K, Haley-Andrews, S, Rannie, M. An observation unit in a pediatric emergency department: one children’s hospital’s experience. JEN 2002:407–413.CrossRefGoogle Scholar
Mallory, MD, Kadish, H, Zebrack, M, et al. Use of a pediatric observation unit for treatment of children with dehydration caused by gastroenteritis. Pediatr Emerg Care 2006; 22(1):16.CrossRefGoogle ScholarPubMed
Miescier, MJ, Nelson, DS, Firth, SD, et al. Children with asthma admitted to a pedictric observation unit. Pediatr Emerg Care 2005: 112: 13021307.Google Scholar
Najaf-Zadeh, A, Hue, V, Bonnel-Motuaire, C, et al. Effectiveness of multifunction paediatric short-saty units: a French multicentre study. Acta Paediatrica 2001; 100:e227e225.2011.Google Scholar
Scribano, PV, Wiley, JF 2nd, Platt, K. Use of an observation unit by a pediatric emergency department for common pediatric illnesses. Pediatric Emergency Care 2001; 17:321323.CrossRefGoogle ScholarPubMed
Zebrack, M, Kadfish, H, Nelson, D. The pediatric hybrid observation unit: analysis of 6477 consecutive patient encounters. Pediatrics 2005; 115(5): e535e542.CrossRefGoogle ScholarPubMed
Wiley, JF. Pediatric clinical decision units: observation, past, present and future. Clin Ped Emerg Med 2001: 2:247252.CrossRefGoogle Scholar
Mace, SE. Pediatric Observation Medicine.Emerg Med Clin North Amer 2001; 19(1): 239254.CrossRefGoogle ScholarPubMed
Beattie, TF, Ferguson, J, Moir, PA. Short-stay facilities in accident and emergency departments for children. Archive of Emergency Medicine 1993; 10: 177180.CrossRefGoogle ScholarPubMed
Macy, ML, Hall, M, Dshah, SS, et al. Differences in designations of observation care in US freestanding children’s hospitals: are they virtual or are they real? Journal of Hospital Medicine 2012; 7:287293.CrossRefGoogle ScholarPubMed
Klein, BL, Patterson, M. Observation unit management of pediatric emergencies. Emerg Med Clin North Amer 1991; 9(3): 669676.CrossRefGoogle ScholarPubMed
Connor, GP, Melzer, SM. Pediatric Observation Units. Pediatrics 2012; 130(1):172179.Google Scholar
Emergency Department Visits. Centers for Disease Control and Prevention. www.cdc.gov/nchs/fastats/ervisits.htm (Accessed March 2016)Google Scholar
Tang, N, Stein, J, Hsia, RY, et al. Trends and characteristics of US emergency department visits, 1997–2007. JAMA 2010; 304(6):664670.CrossRefGoogle ScholarPubMed
Committee on the Future of Emergency Care in the United States Health System. Emergency Care for Children: Growing Pains (ISBN: 0–309-65964–7). ch.1 Introduction, pp.18. National Academies Press. www.nap.edu/catalog/11655.html (Accessed March 2016)Google Scholar
Nawar, EW, Niska, RW, Xu, J; Division of Health Care Statistics. Advance Data from Vital and Health Statistics. National Hospital Ambulatory Medical Care Survey: 2005 Emergency Department Summary, number 386. June 29, 2007.Google Scholar
Mace, SE, Graff, L, Mikhail, M, et al. A national survey of observation units in the United States. Am J Emerg Med 2003; 21:529533.CrossRefGoogle ScholarPubMed
Macy, ML, Stanley, RM, Lozon, MM. Trends in high turnover stays among children hospitalized in the United States, 1993–2003. Pediatrics 2009; 123(3):9961002.CrossRefGoogle ScholarPubMed
McConnochie, KM, Russo, MJ, McBride, JT, et al. How commonly are children hospitalized for asthma eligible for care in alternative settings? Arch Pediatr Adolesc Med 1999; 153:4955.Google ScholarPubMed
McConnochie, KM, Connors, GP, Lu, E. How commonly are children hospitalized for dehydration eligible for care in alternative settings? Arch Pediatr Adolesc med 1999; 153:12331241.CrossRefGoogle ScholarPubMed
DeAngelis, CD. Editor’s Note: How commonly are children hospitalized for asthma eligible for care in alternate settings? Arch Pediatr Adolesc Med 1999; 153: 49.Google Scholar
DeCoster, C, Peterson, S, Karian, P. Manitoba Centre for Health Policy and Evaluation: Report summary alternatives to acute care. Winnipeg, Manitoba, Canada. University of Manitoba – Manitoba Centre for Health Policy and Evaluation, 1996.Google Scholar
Harrop, SN, Morgan, WJ. Emergency care of the elderly in the short-stay ward of the accident and emergency department. Arch Emerg Med 1985; 2:141147.CrossRefGoogle Scholar
Khan, SA. Benefits of an accident and emergency short stay ward in the staged hospital care of elderly patients. J Accid Emerg Med 1997; 14: 151152.CrossRefGoogle ScholarPubMed
Ross, MA, Compton, S, Richardson, D, et al. The use and effectiveness of an emergency department observation unit for elderly patients. Ann Emerg Med (compartative study) 2003 May: 41(5):668677.CrossRefGoogle ScholarPubMed
Madsen, TE, Bledsoe, J, Bossart, P. Appropriately screened geriatric chest pain patients in an observation unit are not admitted at a higher rate than nongeriatric patients. Crit Pathways in Cardiol 2008: 7:245247.CrossRefGoogle Scholar
Zdradzinski, MJ,Phelan, MP,Mace, SE. Impact of frailty and sociodemographic factors on hospital admission from an emergency department observation unit. Amer J Medical Quality (accepted for publication 2016).CrossRefGoogle Scholar
Andre, C, Velasquez, M. Age based health care rationing. Santa Clara University. www.scu.edu/ethics/publications/iie/v3n3/age.html (Last accessed March 21, 2013)Google Scholar
Cipriano, PF. Senior care: are we prepared for the impending health care crisis? Amer Nurse Today 3(8):8.Google Scholar
Francis, T, Fuhrmans, V. Geriatric care is facing crisis. The Wall Street Journal April 15, 2008.Google Scholar
Fischer, JE, Zeiss, AM, Carstensen, LL. Psychopathology of the aging. In: Sutker, PB, Adams, HE (eds.). Comprehensive Handbook of Psychopathology, 2002, ch. 32, pp 921–951.CrossRefGoogle Scholar
Wilber, ST, Gerson, LW, Terrell, KM, et al. Geriatric emergency medicine and the 2006 Institute of Medicine Reports from the Committee on the Future of Emergency Care in the U.S. Health System. Acad Emerg Med 2006; 13:13451351.CrossRefGoogle Scholar
Smith, GP. The elderly and health care rationing. Pierce Law Review 2009;171–182.CrossRefGoogle Scholar
Fuchs, VR. Health care for the elderly. How Much? Who will pay for it? Health Affairs. SMR 1(1):1216.Google Scholar
Gruber, J. The cost implications of health care reform. N Engl J Med 2010: 2050–2051.CrossRefGoogle Scholar
Creditor, MC. Hazards of hospitalization of the elderly. Ann Intern Med 1993; 118:219223.CrossRefGoogle ScholarPubMed
Rothschild, JM, Bates, DW, Leape, LL. Preventable injuries in older patients. Arch Intern Med 2000; 160:27172728.CrossRefGoogle ScholarPubMed
Gill, TM, Allore, HG, Gahbauer, EA, et al. Change in disability after hospitalization or restricted activity in older persons. JAMA 2010; 304:19191926.CrossRefGoogle ScholarPubMed
Boltz, M, Resnick, B, Capezuti, E, et al. Functional decline in hospitalized older adults: can nursing make a difference? Geriatric Nursing 2012: 33(4): 272279.CrossRefGoogle Scholar
Schur, JD, Venkatesh, AK. The growing role of emergency departments in hospital admissions. N Engl J Med 2012;367(5):391393.CrossRefGoogle Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×