Tags

Type your tag names separated by a space and hit enter

An evaluation of emergency physician selection of observation unit patients.
Am J Emerg Med. 2006 May; 24(3):271-9.AJ

Abstract

OBJECTIVE

Appropriate patient selection is critical for maximal observation unit (OU) effectiveness. We hypothesized emergency physicians underuse the OU for admitted patients and overuse the OU for patients who would otherwise be discharged.

METHODS

Treating emergency physicians were asked about patient suitability for admission to an OU at a busy, urban, academic emergency department (ED) as part of a prospective cohort study of ED patients who were admitted or had an ED length of stay exceeding 4 hours. The OU was closed for renovation during the 2-month study, so physician opinion could be compared with patient course in the absence of observation services. Two blinded emergency physicians reviewed charts using structured forms and explicit definitions to determine actual patient course. Hospitalized patients were considered potential OU candidates according to a priori criteria: (1) hospital length of stay less than 48 hours, (2) no procedure or diagnosis requiring hospitalization, and (3) no death.

RESULTS

Of 1747 enrolled patients, 131 were excluded with incomplete data. Median age was 45 years. Patients were 40% white and 48% men. Emergency physicians identified 363 (23%) patients as observation candidates. Of these, 182 (50%) were actually discharged directly. The remaining 181 (50%) were hospitalized; 101 (56%) were observation candidates based on chart review. Of 799 admitted patients not selected for observation, 232 (29%) were suitable for observation by chart review.

CONCLUSIONS

Selection of patients for observation was suboptimal; emergency physicians routinely identified patients as OU candidates who were not ultimately admitted, and they missed many admitted patients who might have been appropriate OU candidates. Both over- and underuse should be addressed to maximize the effectiveness of OUs.

Authors+Show Affiliations

Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0769, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16635696

Citation

Crenshaw, Libby A., et al. "An Evaluation of Emergency Physician Selection of Observation Unit Patients." The American Journal of Emergency Medicine, vol. 24, no. 3, 2006, pp. 271-9.
Crenshaw LA, Lindsell CJ, Storrow AB, et al. An evaluation of emergency physician selection of observation unit patients. Am J Emerg Med. 2006;24(3):271-9.
Crenshaw, L. A., Lindsell, C. J., Storrow, A. B., & Lyons, M. S. (2006). An evaluation of emergency physician selection of observation unit patients. The American Journal of Emergency Medicine, 24(3), 271-9.
Crenshaw LA, et al. An Evaluation of Emergency Physician Selection of Observation Unit Patients. Am J Emerg Med. 2006;24(3):271-9. PubMed PMID: 16635696.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An evaluation of emergency physician selection of observation unit patients. AU - Crenshaw,Libby A, AU - Lindsell,Christopher J, AU - Storrow,Alan B, AU - Lyons,Michael S, PY - 2005/06/28/received PY - 2005/09/15/revised PY - 2005/11/07/accepted PY - 2006/4/26/pubmed PY - 2006/7/14/medline PY - 2006/4/26/entrez SP - 271 EP - 9 JF - The American journal of emergency medicine JO - Am J Emerg Med VL - 24 IS - 3 N2 - OBJECTIVE: Appropriate patient selection is critical for maximal observation unit (OU) effectiveness. We hypothesized emergency physicians underuse the OU for admitted patients and overuse the OU for patients who would otherwise be discharged. METHODS: Treating emergency physicians were asked about patient suitability for admission to an OU at a busy, urban, academic emergency department (ED) as part of a prospective cohort study of ED patients who were admitted or had an ED length of stay exceeding 4 hours. The OU was closed for renovation during the 2-month study, so physician opinion could be compared with patient course in the absence of observation services. Two blinded emergency physicians reviewed charts using structured forms and explicit definitions to determine actual patient course. Hospitalized patients were considered potential OU candidates according to a priori criteria: (1) hospital length of stay less than 48 hours, (2) no procedure or diagnosis requiring hospitalization, and (3) no death. RESULTS: Of 1747 enrolled patients, 131 were excluded with incomplete data. Median age was 45 years. Patients were 40% white and 48% men. Emergency physicians identified 363 (23%) patients as observation candidates. Of these, 182 (50%) were actually discharged directly. The remaining 181 (50%) were hospitalized; 101 (56%) were observation candidates based on chart review. Of 799 admitted patients not selected for observation, 232 (29%) were suitable for observation by chart review. CONCLUSIONS: Selection of patients for observation was suboptimal; emergency physicians routinely identified patients as OU candidates who were not ultimately admitted, and they missed many admitted patients who might have been appropriate OU candidates. Both over- and underuse should be addressed to maximize the effectiveness of OUs. SN - 0735-6757 UR - https://www.unboundmedicine.com/medline/citation/16635696/An_evaluation_of_emergency_physician_selection_of_observation_unit_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-6757(05)00411-0 DB - PRIME DP - Unbound Medicine ER -