Beyond observation: Protocols and capabilities of an Emergency Department Observation Unit
| Autor: | Michael Barrie, Eric J. Adkins, Lauren T. Southerland, Anthony J. Vargas, Margaret Krebs, Steffen R. Simerlink, Lalitha Nagaraj, Krystin N. Miller |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Chest pain 03 medical and health sciences 0302 clinical medicine Patient Admission Clinical Protocols Clinical Observation Units THIRTY-DAY Medicine Humans Practice Patterns Physicians' Aged Quality Indicators Health Care Retrospective Studies Aged 80 and over business.industry 030208 emergency & critical care medicine Admission rate General Medicine Emergency department Length of Stay Middle Aged Gastrostomy Quality Improvement Catheter Outcome and Process Assessment Health Care Nephrostomy Emergency medicine Emergency Medicine Female medicine.symptom business Emergency Service Hospital Observation unit |
| Zdroj: | The American journal of emergency medicine. 37(10) |
| ISSN: | 1532-8171 |
| Popis: | Objective Emergency Department Observation Units (Obs Units) provide a setting and a mechanism for further care of Emergency Department (ED) patients. Our hospital has a protocol-driven, type 1, complex 20 bed Obs Unit with 36 different protocols. We wanted to understand how the different protocols performed and what types of care were provided. Methods This was an IRB-approved, retrospective chart review study. A random 10% of ED patient charts with a “transfer to observation” order were selected monthly from October 2015 through June 2017. This database was designed to identify high and low functioning protocols based on length of stays (LOS) and admission rates. Results Over 20 months, a total of 984 patients qualified for the study. The average age was 49.5 ± 17.2 years, 57.3% were women, and 32.3% were non-Caucasian. The admission rate was 23.5% with an average LOS in observation of 13.7 h [95% CI 13.3–14.1]. Thirty day return rate was 16.8% with 5.3% of the patients returning to the ED within the first 72 h. Thirty six different protocols were used, with the most common being chest pain (13.9%) and general (13.2%). Almost 70% received a consultation from another service, and 7.2% required a procedure while in observation. Procedures included fluoroscopic-guided lumbar punctures, endoscopies, dental extractions, and catheter replacements (nephrostomy, gastrostomy, and biliary tubes). Conclusions An Obs Unit can care for a wide variety of patients who require multiple consultations, procedures, and care coordination while maintaining an acceptable length of stay and admission rate. |
| Databáze: | OpenAIRE |
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