National Study of Emergency Department Observation Services

Authors

  • Jennifer L. Wiler MD, MBA,

    1. From the Department of Emergency Medicine, University of Colorado School of Medicine (JLW, AAG), Aurora, CO; the Division of Emergency Medicine, Washington University in St. Louis School of Medicine (JLW), St. Louis, MO; and the Department of Emergency Medicine, Emory University (MAR), Atlanta, GA.
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  • Michael A. Ross MD,

    1. From the Department of Emergency Medicine, University of Colorado School of Medicine (JLW, AAG), Aurora, CO; the Division of Emergency Medicine, Washington University in St. Louis School of Medicine (JLW), St. Louis, MO; and the Department of Emergency Medicine, Emory University (MAR), Atlanta, GA.
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  • Adit A. Ginde MD, MPH

    1. From the Department of Emergency Medicine, University of Colorado School of Medicine (JLW, AAG), Aurora, CO; the Division of Emergency Medicine, Washington University in St. Louis School of Medicine (JLW), St. Louis, MO; and the Department of Emergency Medicine, Emory University (MAR), Atlanta, GA.
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  • Presented at the American College of Emergency Physicians Scientific Assembly Research Forum, Las Vegas, NV, September 2010.

  • The authors have no relevant financial information or potential conflicts of interest to disclose.

  • Supervising Editor: Jacob Ufberg, MD.

Address for correspondence and reprints: Jennifer L. Wiler, MD, MBA; e-mail: jenniferwiler@ucdenver.edu.

Abstract

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.

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