Annals of Emergency Medicine
Volume 41, Issue 5 , Pages 668-677 , May 2003

The use and effectiveness of an emergency department observation unit for elderly patients

Preliminary results of this study were presented at the Society for Academic Emergency Medicine annual conference, Atlanta, GA, May 2001.

Received 14 May 2002 ,Revised 8 November 2002 ,Accepted 6 December 2002.

References 

  1. Yealy DM, De Hart DA, Ellis G, et al.  A survey of observation units in the United States. Am J Emerg Med. 1989;7:576–580
  2. Roberts RR, Zalenski RJ, Mensah EK, et al.  Costs of an emergency department-based accelerated diagnostic protocol vs hospitalization in patients with chest pain: a randomized controlled trial. JAMA. 1997;278:1670–1676
  3. Zalenski RJ, McCarren M, Roberts R, et al.  An evaluation of a chest pain diagnostic protocol to exclude acute cardiac ischemia in the emergency department. Arch Intern Med. 1997;157:1085–1091
  4. Rydman RJ, Zalenski RJ, Roberts RR, et al.  Patient satisfaction with an emergency department chest pain observation unit. Ann Emerg Med. 1997;29:109–115
  5. Rydman RJ, Roberts RR, Albrecht GL, et al.  Patient satisfaction with an emergency department asthma observation unit. Acad Emerg Med. 1999;6:178–183
  6. Gomez MA, Anderson JL, Karagounis LA, et al.  An emergency department-based protocol for rapidly ruling out myocardial ischemia reduces hospital time and expense: results of a randomized study (ROMIO). J Am Coll Cardiol. 1996;28:25–33
  7. McDermott MF, Murphy DG, Zalenski RJ, et al.  A comparison between emergency diagnostic and treatment unit and inpatient care in the management of acute asthma. Arch Intern Med. 1997;157:2055–2062
  8. Brillman J, Mathers-Dunbar L, Graff L, et al.  Management of observation units. American College of Emergency Physicians. Ann Emerg Med. 1995;25:823–830
  9. Hadden DS, Dearden CH, Rocke LG. Short stay observation patients: general wards are inappropriate. J Accid Emerg Med. 1996;13:163–165
  10. Rothschild JM, Bates DW, Leape LL. Preventable medical injuries in older patients. Arch Intern Med. 2000;160:2717–2728
  11. Creditor MC. Hazards of hospitalization of the elderly. Ann Intern Med. 1993;118:219–223
  12. In: Federal Register. Vol. 66, No. 231, Part 3. November 30, 2001;p. 59879–59883 Available at http://www.access.gpo.gov/su_docs/fedreg/a011130c.htmlApril 9, 2002; Accessed
  13. Khan SA, Millington H, Miskelly FG. Benefits of an accident and emergency short stay ward in the staged hospital care of elderly patients. J Accid Emerg Med. 1997;14:151–152
  14. Harrop SN, Morgan WJ. Emergency care of the elderly in the short-stay ward of the accident and emergency department. Arch Emerg Med. 1985;2:141–147
  15. Koenig BO, Ross MA, Jackson RE. An emergency department observation unit protocol for acute-onset atrial fibrillation is feasible. Ann Emerg Med. 2002;39:374–381
  16. Ross M. Guidelines and clinical pathways. In:  Graff LG editors. Observation Units, Implementation, and Management Strategies. Dallas, TX: American College of Emergency Medicine; 1998;p. 23–36
  17. Ross MA, Naylor S, Compton S, et al.  Maximizing use of the emergency department observation unit: a novel hybrid design. Ann Emerg Med. 2001;37:267–274
  18. Martinez E, Reilly BM, Evans AT, et al.  The observation unit: a new interface between inpatient and outpatient care. Am J Med. 2001;110:274–277
  19. Gouin S, Macarthur C, Parkin PC, et al.  Effect of a pediatric observation unit on the rate of hospitalization for asthma. Ann Emerg Med. 1997;29:218–222
  20. Farkouh ME, Smars PA, Reeder GS, et al.  A clinical trial of a chest-pain observation unit for patients with unstable angina. Chest Pain Evaluation in the Emergency Room (CHEER) Investigators. N Engl J Med. 1998;339:1882–1888
  21. HCFA Intermediary Manual. Chapter VII—Bill Review 2001 Available at http://www.hcfa.gov/pubforms/13_int/a3660.htm #_3663_0April 9, 2002; Accessed
  22. Zalenski RJ, Rydman RJ, McCarren M, et al.  Feasibility of a rapid diagnostic protocol for an emergency department chest pain unit. Ann Emerg Med. 1997;29:99–108
  23. Mikhail MG, Smith FA, Gray M, et al.  Cost-effectiveness of mandatory stress testing in chest pain center patients. Ann Emerg Med. 1997;29:88–98
  24. Henneman PL, Marx JA, Cantrill SC, et al.  The use of an emergency department observation unit in the management of abdominal trauma. Ann Emerg Med. 1989;18:647–650
  25. Rydman RJ, Isola ML, Roberts RR, et al.  Emergency department observation unit versus hospital inpatient care for a chronic asthmatic population: a randomized trial of health status outcome and cost. Med Care. 1998;36:599–609
  26. McCarren M, Zalenski RJ, McDermott M, et al.  Predicting recovery from acute asthma in an emergency diagnostic and treatment unit. Acad Emerg Med. 2000;7:28–35
  27. Zwicke DL, Donohue JF, Wagner EH. Use of the emergency department observation unit in the treatment of acute asthma. Ann Emerg Med. 1982;11:77–83
  28. McKesson Health Solutions LLC. Interqual, Acute Care: Intensity of Service, Severity of Illness, and Discharge Screens (ISD-AC)-Adult. Marlborough, MA: McKesson Health Solutions LLC; 2000;
  29. McCusker J, Kakuma R, Abrahamowicz M. Predictors of functional decline in hospitalized elderly patients: a systematic review. J Gerontol A Biol Sci Med Sci. 2002;57:M569–M577
  30. Thomas DR. Focus on functional decline in hospitalized older adults. J Gerontol A Biol Sci Med Sci. 2002;57:M567–M568
  31. Lowenstein SR, Crescenzi CA, Kern DC, et al.  Care of the elderly in the emergency department. Ann Emerg Med. 1986;15:528–535
  32. Angelos WJ. A survey of patients 65 years of age or older discharged from the emergency department. Ann Emerg Med. 1993;22:953–954
  33. Chin MH, Jin L, Karrison TG, et al.  Older patients' health-related quality of life around an episode of emergency illness. Ann Emerg Med. 1999;34:595–603
  34. Polanczyk CA, Johnson PA, Hartley LH, et al.  Clinical correlates and prognostic significance of early negative exercise tolerance test in patients with acute chest pain seen in the hospital emergency department. Am J Cardiol. 1998;81:288–292
  35. Roberts R, Graff LG. Economic issues in observation unit medicine. Emerg Med Clin North Am. 2001;19:19–33
  36. Cohen HJ, Feussner JR, Weinberger M, et al.  A controlled trial of inpatient and outpatient geriatric evaluation and management. N Engl J Med. 2002;346:905–912
  37. Lee TH, Pearson SD, Johnson PA, et al.  Failure of information as an intervention to modify clinical management. A time-series trial in patients with acute chest pain. Ann Intern Med. 1995;122:434–437
  38. Ellrodt AG, Conner L, Riedinger M, et al.  Measuring and improving physician compliance with clinical practice guidelines. A controlled interventional trial. Ann Intern Med. 1995;122:277–282
  39. Graff L, Delara J, Ross M, et al.  Chest Pain Evaluation Registry (CHEPER) Study: impact on the care of the emergency department chest pain patient. Am J Cardiol. 1997;80:563–568

☆ The authors report this study did not receive any outside funding or support.

☆☆ Address for reprints: Michael Ross, MD, Emergency Medicine, 3601 W. Thirteen Mile Road, Royal Oak, MI 48073-6769; 248-551-3080, fax 248-551-2016; E-mail maross@beaumont.edu .

PII: S0196-0644(03)00169-0

doi: 10.1067/mem.2003.153

Annals of Emergency Medicine
Volume 41, Issue 5 , Pages 668-677 , May 2003

Article Tools

* Image Usage & Resolution