Annals of Emergency Medicine
Volume 56, Issue 1 , Pages 34-41 , July 2010

The Recidivism Characteristics of an Emergency Department Observation Unit

  • Michael A. Ross, MD

      Affiliations

    • Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA
    • Corresponding Author InformationAddress for correspondence: Michael A. Ross, MD, Department of Emergency Medicine, Emory University School of Medicine, 531 Asbury Circle-Annex, Ste N340, Atlanta, GA 30322; 404-778-2643, fax 404-778-2630
  • ,
  • Robin R. Hemphill, MD, MPH

      Affiliations

    • Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA
  • ,
  • Jerome Abramson, PhD

      Affiliations

    • Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA
  • ,
  • Kim Schwab, PA

      Affiliations

    • Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA
  • ,
  • Carol Clark, MD

      Affiliations

    • Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI

Received 9 October 2009 ,Revised 28 January 2010 ,Accepted 9 February 2010.

References 

  1. Mace SE, Graff L, Mikhail M, et al. A national survey of observation units in the United States. Am J Emerg Med. 2003;21:529–533
  2. Mace SE, Shah J. Observation medicine in emergency medicine residency programs. Acad Emerg Med. 2002;9:169–171
  3. 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
  4. Ross MA, Compton S, Richardson D, et al. The use and effectiveness of an emergency department observation unit for elderly patients. Ann Emerg Med. 2003;41:668–677
  5. 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
  6. Ross MA, Compton S, Medado P, et al. An emergency department diagnostic protocol for patients with transient ischemic attack: a randomized controlled trial. Ann Emerg Med. 2007;50:109–119
  7. 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
  8. 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
  9. 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
  10. Kelen GD, Scheulen JJ, Hill PM. Effect of an emergency department (ED) managed acute care unit on ED overcrowding and emergency medical services diversion. Acad Emerg Med. 2001;8:1095–1100
  11. 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
  12. Rydman RJ, Roberts RR, Albrecht GL, et al. Patient satisfaction with an emergency department asthma observation unit. Acad Emerg Med. 1999;6:178–183
  13. 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
  14. Graff L, Radford MJ, Werne C. Probability of appendicitis before and after observation. Ann Emerg Med. 1991;20:503–507
  15. Graff LG, Dallara J, Ross MA, et al. Impact on the care of the emergency department chest pain patient from the Chest Pain Evaluation Registry (CHEPER) study. Am J Cardiol. 1997;80:563–568
  16. Maag R, Krivenko C, Graff L, et al. Improving chest pain evaluation within a multihospital network by the use of emergency department observation units. Jt Comm J Qual Improv. 1997;23:312–320
  17. Rentz AC, Kadish HA, Nelson DS. Physician satisfaction with a pediatric observation unit administered by pediatric emergency medicine physicians. Pediatr Emerg Care. 2004;20:430–432
  18. Hostetler B, Leikin JB, Timmons JA, et al. Patterns of use of an emergency department-based observation unit. Am J Ther. 2002;9:499–502
  19. Mace SE. Pediatric observation medicine. Emerg Med Clin North Am. 2001;19:239–254
  20. Shen WK, Decker WW, Smars PA, et al. Syncope Evaluation in the Emergency Department Study (SEEDS): a multidisciplinary approach to syncope management. Circulation. 2004;110:3636–3645
  21. Kosowsky JM, Gasaway MD, Hamilton CA, et al. Preliminary experience with an emergency department observation unit protocol for heart failure. Acad Emerg Med. 2000;7:1171
  22. Keith KD, Bocka JJ, Kobernick MS, et al. Emergency department revisits. Ann Emerg Med. 1989;18:964–968
  23. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360:1418–1428
  24. Cardin S, Afilalo M, Lang E, et al. Intervention to decrease emergency department crowding: does it have an effect on return visits and hospital readmissions?. Ann Emerg Med. 2003;41:173–185
  25. 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
  26. 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
  27. Ross MA, Graff LG. Principles of observation medicine. Emerg Med Clin North Am. 2001;19:1–17
  28. Emergency department observation services. Ann Emerg Med. 2008;51:686
  29. Lindsay P, Schull M, Bronskill S, et al. The development of indicators to measure the quality of clinical care in emergency departments following a modified-Delphi approach. Acad Emerg Med. 2002;9:1131–1139
  30. Nunez S, Hexdall A, Aguirre-Jaime A. Unscheduled returns to the emergency department: an outcome of medical errors?. Qual Saf Health Care. 2006;15:102–108
  31. Aminzadeh F, Dalziel WB. Older adults in the emergency department: a systematic review of patterns of use, adverse outcomes, and effectiveness of interventions. Ann Emerg Med. 2002;39:238–247
  32. Storrow AB, Collins SP, Lyons MS, et al. Emergency department observation of heart failure: preliminary analysis of safety and cost. Congest Heart Fail. 2005;11:68–72
  33. Anderson GF, Steinberg EP. Hospital readmissions in the Medicare population. N Engl J Med. 1984;311:1349–1353
  34. Epstein AM. Revisiting readmissions—changing the incentives for shared accountability. N Engl J Med. 2009;360:1457–1459
  35. Catalano K. Pay-for-performance and recovery audit contractors: the whys and wherefores of these programs. Plast Surg Nurs. 2009;29:179–182
  36. Terra SM. Regulatory issues: recovery audit contractors and their impact on case management. Prof Case Manag. 2009;14:217–223
  37. Bohan JS. Extended emergency care for painful conditions. Emerg Med Clin North Am. 2001;19:233–238ix

 Please see page 35 for the Editor's Capsule Summary of this article.

 Provide feedback on this article at the journal's Web site, www.annemergmed.com.

 Supervising editor: Donald M. Yealy, MD

 Author contributions: MAR and KS conceived and designed the study and were involved in data collection and validation. CC obtained institutional review board approval. MAR, RRH, JA, KS, and CC were involved in data analysis and article preparation. All authors were involved in final article revisions. MR takes responsibility for the paper as a whole.

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.

 Publication date: Available online March 29, 2010.

 Reprints not available from the authors.

PII: S0196-0644(10)00146-0

doi: 10.1016/j.annemergmed.2010.02.012

Annals of Emergency Medicine
Volume 56, Issue 1 , Pages 34-41 , July 2010