Beyond observation: Protocols and capabilities of an Emergency Department Observation Unit

Southerland, Lauren T.; Simerlink, S.R.; Vargas, Anthony J.; Krebs, Margaret; Nagaraj, Lalitha; Miller, Krystin N.; Adkins, Eric; Barrie, Michael

doi:10.1016/j.ajem.2018.12.049

Cited by 14 publications

(5 citation statements)

References 23 publications

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“…Our results are similar to those reported in two previous studies of academic EDOUs conducted by Ross et al and Southerland et al 6 , 7 In addition to having a similar average age and percentage female, we found no statistically significant difference between the return rates of males and females and the makeup of the EDOU at large. 6 While our EDOU’s 14.9% hospital admission rate was somewhat lower than the 19% and 23.5% reported by Ross and Southerland, respectively, we found percentages of EDOU patients who returned similar to those reported by Ross (9.4% vs 10.7%).…”

Section: Discussionsupporting

confidence: 92%

“… 6 While our EDOU’s 14.9% hospital admission rate was somewhat lower than the 19% and 23.5% reported by Ross and Southerland, respectively, we found percentages of EDOU patients who returned similar to those reported by Ross (9.4% vs 10.7%). 6 , 7 Our rate of returns related to the initial visit was also similar to that found in the Ross study (65% vs 74%). 6 We were unable to locate any previous studies that attempted to determine whether the EDOU return visits were potentially avoidable.…”

Section: Discussionsupporting

confidence: 86%

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Returns After Discharge From the Emergency Department Observation Unit: Who, What, When, and Why?

Berger¹,

King²,

Caldwell³

et al. 2023

WestJEM

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Introduction The number of emergency department observation units (EDOU) and observation stays has continued to increase. Despite this, there is limited data on the characteristics of patients who return unexpectedly to the ED after EDOU discharge. Methods We identified the charts of all patients who were admitted to the EDOU of an academic medical center between January 2018–June 2020 and had a return to the ED within 14 days of discharge from the EDOU. Patients were excluded if they were admitted to the hospital from the EDOU, left against medical advice, or died in the EDOU. We manually extracted selected demographic factors, comorbidities, and healthcare utilization data from the charts. Physician reviewers identified return visits thought to be related to the index visit or potentially avoidable. Results During the study period, there were 176,471 ED visits, 4,179 admissions to the EDOU, and 333 return visits to the ED within 14 days from discharge from the EDOU, representing 9.4% of all patients discharged from the EDOU. We identified a higher rate of return for patients treated for asthma and lower rates of return for patients treated for chest pain or syncope than the overall return rate. Physician reviewers determined that 64.6% of unplanned returns were related to the index visit, and 4.5% were potentially avoidable. Of potentially avoidable visits, 53.3% occurred within 48 hours of discharge, supporting the use of this period as a potential quality metric. While there was no significant difference in the percentage of related return visits between males and females, there was a higher rate of potentially avoidable visits for male patients. Conclusion This study adds to the limited body of literature on EDOU returns, finding an overall return rate of under 10%, with about two-thirds of returns determined to be related to the index visit and <5% considered to be potentially avoidable.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 86%

Returns After Discharge From the Emergency Department Observation Unit: Who, What, When, and Why?

Berger¹,

King²,

Caldwell³

et al. 2023

WestJEM

View full text Add to dashboard Cite

show abstract

“…Future work focusing on patient centered outcomes, such as mortality, will be explored. Additionally, novel interventions such as ED‐observation unit‐based biopsies could be arranged, especially for the most vulnerable patients, which is usually the largest hurdle toward cancer staging and definitive diagnosis 10 . In conclusion, this work suggests ED physicians are efficient at identifying patients with likely cancer and thus needing expeditious biopsy.…”

Section: N = 28 (Unless Otherwise Specified) 95% CImentioning

confidence: 87%

“…the most vulnerable patients, which is usually the largest hurdle toward cancer staging and definitive diagnosis 10. In conclusion, this work suggests ED physicians are efficient at identifying patients with likely cancer and thus needing expeditious biopsy.…”

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confidence: 80%

Novel referral pathway for patients with new solid tumors discharged from the emergency department: A pilot study

Pettit

Al‐Hader

2021

Academic Emergency Medicine

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Many patients with undiagnosed cancer have a preceding emergency department (ED) visit that has a workup concerning for cancer. 1 A diagnosis of cancer following an ED visit is associated with inferior patient-reported and clinical outcomes compared to patients that are diagnosed through routine screening. 1 Little prospective data exists describing the care for patients diagnosed with cancer from an ED visit. 1,2 Delays in time to treatment for new cancer diagnoses continue to increase, with absolute increased risk of mortality ranging from 1.2 to 3.2% per week in curative settings with various early-staged cancers. 3 Patients whose care was coordinated through their primary care physician experienced longer delays than patients who saw specialists directly, and in one analysis 29% of patients with lung cancer experienced a wait of 90 days or more. 4 Reasons for prolonged time to treatment are multifactorial, as delays can be experienced for tissue sampling, tumor board discussion, and staging. 5 It is currently unknown how the transitions of care from the ED impact these times.

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“…For example, instead of needing to have a PT available at 8 pm when the patient is getting their ED evaluation, the patient can be kept in observation to see the PT at 8 am. This process has been shown to be feasible and effective in Obs Units around the world, but is not standard care in the USA [18,[34][35][36][37].…”

Section: The Consolidated Framework For Implementation Researchmentioning

confidence: 99%

Study protocol for IMAGE: implementing multidisciplinary assessments for geriatric patients in an emergency department observation unit, a hybrid effectiveness/implementation study using the Consolidated Framework for Implementation Research

Southerland

Mion

Moffatt-Bruce

et al. 2020

Implement Sci Commun

Self Cite

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Background: Older adults in the emergency department (ED) are at high risk for functional decline, unrecognized delirium, falls, and medication interactions. Holistic assessment by a multidisciplinary team in the ED decreases these adverse outcomes and decreases admissions, but there are many barriers to incorporating this type of care during the ED visit. Methods: This is a hybrid type II effectiveness-implementation study using a pre-/post-cohort design (n = 380) at a tertiary care academic ED with an ED observation unit (Obs Unit). The intervention is a two-step protocol of (step 1) ED nurses screening adult patients ≥ 65 years old for geriatric needs using the Delirium Triage Screen, 4-Stage Balance Test, and the Identifying Seniors at Risk score. Patients who have geriatric needs identified by this screening but who do not meet hospital admission criteria will (step 2) be placed in the Obs Unit for multidisciplinary geriatric assessment by the hospital's geriatric consultation team, physical therapists, occupational therapists, pharmacists, and/or case managers. Not all patients may require all elements of the multidisciplinary geriatric assessment. The Consolidated Framework for Implementation Research: Care Transitions Framework was used to identify barriers to implementation. Lean Six Sigma processes will be used to overcome these identified barriers with the goal of achieving geriatric screening rates of > 80%. Implementation success and associated factors will be reported. For the effectiveness aim, pre-/post-cohorts of adults ≥ 65 years old cared for in the Obs Unit will be followed for 90 days postED visit (n = 150 pre and 230 post). The primary outcome is the prevention of functional decline. Secondary outcomes include health-related quality of life, new geriatric syndromes identified, new services provided, and Obs Unit metrics such as length of stay and admission rates.

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Beyond observation: Protocols and capabilities of an Emergency Department Observation Unit

Cited by 14 publications

References 23 publications

Returns After Discharge From the Emergency Department Observation Unit: Who, What, When, and Why?

Returns After Discharge From the Emergency Department Observation Unit: Who, What, When, and Why?

Novel referral pathway for patients with new solid tumors discharged from the emergency department: A pilot study

Study protocol for IMAGE: implementing multidisciplinary assessments for geriatric patients in an emergency department observation unit, a hybrid effectiveness/implementation study using the Consolidated Framework for Implementation Research

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