Observation unit activity in a community hospital

Estella A, Pérez-Bello Fontaiña L, Sánchez Angulo JI, Toledo Coello MD, Del Aguila Quirós D

Objective: To describe the characteristics of patients admitted to our community

hospital emergency observation unit; calculate the percentage of patients discharged,

admitted, or transferred to other hospitals; and evaluate the reasons for hospital

admission and consistency between emergency and hospital ward discharge diagnoses.

Methods: Data for patients admitted to a 24-bed observation unit were studied.

Variables analyzed were age, sex, comorbidity, destination on discharge from the

emergency department (home, observation unit, hospital ward, or transfer to another

hospital), consistency between emergency department and hospital ward diagnoses,

and admission appropriateness (defined by a stay of > 72 hours on the hospital ward).

Results: A total of 307 patients were included. The mean (SD) age was 63 (20) years and

41% were female. Fifty-one percent had a chronic condition related to the reason for

seeking emergency care. The reason for observation unit admission that was of highest

prevalence was chest pain (16.6%). Forty-six percent were discharged home from the

observation unit and 46% were admitted, primarily to specialized medical wards. The

most common discharge diagnoses were acute coronary syndrome (12.1%), pneumonia

(10%), heart failure (7.1%), respiratory failure (6.4%), and stroke (6.4%). The hospital

discharge diagnosis was consistent with the emergency department diagnosis in 89.3%

of the cases and admission to a ward was considered appropriate in 93%.

Conclusions: Observation unit patients are usually over 60 years old and have chronic

diseases related to the reason they require emergency care. Most hospital admissions

made from the observation unit are appropriate and there is good consistency between

the emergency department diagnosis and the ultimate hospital discharge diagnosis.

Del Aguila Quirós D, Estella A, Pérez-Bello Fontaiña L, Sánchez Angulo JI, Toledo Coello MD