Use of Observation Care in US Emergency Departments, 2001 to 2008
Author Information
Author(s): Venkatesh Arjun K., Geisler Benjamin P., Gibson Chambers Jennifer J., Baugh Christopher W., Bohan J. Stephen, Schuur Jeremiah D.
Primary Institution: Brigham and Women's Hospital-Massachusetts General Hospital-Harvard Affiliated Emergency Medicine Residency
Hypothesis
The proportion of ED patients receiving observation services has increased over time, and that the relative frequency of ED patients placed in observation will be higher in hospitals with dedicated OUs.
Conclusion
One-third of US hospitals have dedicated observation units, and observation care is increasingly used for a range of clinical conditions.
Supporting Evidence
- In 2007-2008, 34.1% of all EDs had a dedicated observation unit.
- ED visits resulting in a disposition to observation increased from 642,000 in 2001 to 2,318,000 in 2008.
- Chest pain was the most common reason for ED visit resulting in observation.
Takeaway
This study found that many emergency departments in the US have special areas for patients who need to be watched closely but not admitted to the hospital, and more patients are being placed in these areas over time.
Methodology
Retrospective analysis using the National Hospital Ambulatory Medical Care Survey (NHAMCS) data from 2001 to 2008.
Potential Biases
Potential for overuse of observation services for patients that could have been discharged.
Limitations
Changes in survey questions over time and inability to evaluate care given during OU stay.
Participant Demographics
Data included a diverse range of patients visiting emergency departments across the US.
Statistical Information
P-Value
p<0.05
Confidence Interval
95%CI: 27.95%–41.15%
Statistical Significance
p<0.05
Digital Object Identifier (DOI)
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