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Effect of a Multi-Diagnosis Observation Unit on Emergency Department Length of Stay and Inpatient Admission Rate at Two Canadian Hospitals.
J Emerg Med. 2016 Dec; 51(6):739-747.e3.JE

Abstract

BACKGROUND

Observation units (OUs) have been shown to reduce emergency department (ED) lengths of stay (LOS) and admissions. Most published studies have been on OUs managing single complaints.

OBJECTIVE

Our aim was to determine whether an OU reduces ED LOS and hospital admission rates for adults with a variety of presenting complaints.

METHODS

We comparatively evaluated two hospitals in British Columbia, Canada (hereafter ED A and ED B) using a pre-post design. Data were extracted from administrative databases. The post-OU cohort included all adults presenting 6 months after OU implementation. The pre-OU cohort included all adults presenting in the same 6-month period 1 year before OU implementation.

RESULTS

There were 109,625 patient visits during the study period. Of the 56,832 visits during the post-OU period (27,512 to ED A and 29,318 to ED B), 1.9% were managed in the OU in ED A and 1.4% in ED B. Implementation was associated with an increase in the median ED LOS at ED A (179.0 min pre vs. 192.0 min post [+13.0 min]; p < 0.001; mean difference -12.5 min, 95% confidence interval [CI] -15.2 to -9.9 min), but no change at ED B (182.0 min pre vs. 182.0 min post; p = 0.55; mean difference +2.0 min, 95% CI -0.7 to +4.7 min). Implementation significantly decreased the hospital admission rate for ED A (17.8% pre to 17.0% post [-0.8%], 95% CI -0.18% to 0.15%; p < 0.05) and did not significantly change the hospital admission rate at ED B (18.9% pre to 18.3% post [-0.6%], 95% CI -1.19% to -0.09%; p = 0.09).

CONCLUSIONS

A multi-diagnosis OU can reduce hospital admission rate in a site-specific manner. In contrast to previous studies, we did not find that an OU reduced ED LOS. Further research is needed to determine whether OUs can reduce ED overcrowding.

Authors+Show Affiliations

Department of Emergency Medicine, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada.Department of Emergency Medicine, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada.Department of Emergency Medicine, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada.

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study

Language

eng

PubMed ID

27687168

Citation

Cheng, Amy H Y., et al. "Effect of a Multi-Diagnosis Observation Unit On Emergency Department Length of Stay and Inpatient Admission Rate at Two Canadian Hospitals." The Journal of Emergency Medicine, vol. 51, no. 6, 2016, pp. 739-747.e3.
Cheng AHY, Barclay NG, Abu-Laban RB. Effect of a Multi-Diagnosis Observation Unit on Emergency Department Length of Stay and Inpatient Admission Rate at Two Canadian Hospitals. J Emerg Med. 2016;51(6):739-747.e3.
Cheng, A. H. Y., Barclay, N. G., & Abu-Laban, R. B. (2016). Effect of a Multi-Diagnosis Observation Unit on Emergency Department Length of Stay and Inpatient Admission Rate at Two Canadian Hospitals. The Journal of Emergency Medicine, 51(6), 739-e3. https://doi.org/10.1016/j.jemermed.2015.12.024
Cheng AHY, Barclay NG, Abu-Laban RB. Effect of a Multi-Diagnosis Observation Unit On Emergency Department Length of Stay and Inpatient Admission Rate at Two Canadian Hospitals. J Emerg Med. 2016;51(6):739-747.e3. PubMed PMID: 27687168.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of a Multi-Diagnosis Observation Unit on Emergency Department Length of Stay and Inpatient Admission Rate at Two Canadian Hospitals. AU - Cheng,Amy H Y, AU - Barclay,Neil G, AU - Abu-Laban,Riyad B, Y1 - 2016/09/27/ PY - 2015/05/26/received PY - 2015/11/26/revised PY - 2015/12/15/accepted PY - 2016/10/1/pubmed PY - 2017/10/11/medline PY - 2016/10/1/entrez KW - admission rates KW - clinical decision units KW - diagnostic treatment units KW - emergency department KW - length of stay KW - observation unit KW - overcrowding SP - 739 EP - 747.e3 JF - The Journal of emergency medicine JO - J Emerg Med VL - 51 IS - 6 N2 - BACKGROUND: Observation units (OUs) have been shown to reduce emergency department (ED) lengths of stay (LOS) and admissions. Most published studies have been on OUs managing single complaints. OBJECTIVE: Our aim was to determine whether an OU reduces ED LOS and hospital admission rates for adults with a variety of presenting complaints. METHODS: We comparatively evaluated two hospitals in British Columbia, Canada (hereafter ED A and ED B) using a pre-post design. Data were extracted from administrative databases. The post-OU cohort included all adults presenting 6 months after OU implementation. The pre-OU cohort included all adults presenting in the same 6-month period 1 year before OU implementation. RESULTS: There were 109,625 patient visits during the study period. Of the 56,832 visits during the post-OU period (27,512 to ED A and 29,318 to ED B), 1.9% were managed in the OU in ED A and 1.4% in ED B. Implementation was associated with an increase in the median ED LOS at ED A (179.0 min pre vs. 192.0 min post [+13.0 min]; p < 0.001; mean difference -12.5 min, 95% confidence interval [CI] -15.2 to -9.9 min), but no change at ED B (182.0 min pre vs. 182.0 min post; p = 0.55; mean difference +2.0 min, 95% CI -0.7 to +4.7 min). Implementation significantly decreased the hospital admission rate for ED A (17.8% pre to 17.0% post [-0.8%], 95% CI -0.18% to 0.15%; p < 0.05) and did not significantly change the hospital admission rate at ED B (18.9% pre to 18.3% post [-0.6%], 95% CI -1.19% to -0.09%; p = 0.09). CONCLUSIONS: A multi-diagnosis OU can reduce hospital admission rate in a site-specific manner. In contrast to previous studies, we did not find that an OU reduced ED LOS. Further research is needed to determine whether OUs can reduce ED overcrowding. SN - 0736-4679 UR - https://www.unboundmedicine.com/medline/citation/27687168/Effect_of_a_Multi_Diagnosis_Observation_Unit_on_Emergency_Department_Length_of_Stay_and_Inpatient_Admission_Rate_at_Two_Canadian_Hospitals_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0736-4679(16)30459-0 DB - PRIME DP - Unbound Medicine ER -