The short-stay emergency observation ward is here to stay

The traditional venue for the management of most medical and surgical emerg encies has been the in-hospital environment. It is only when patients have been fully evaluated and treated that they are discharged. The increasing c ost of hospital stay and burgeoning cost of health care are forcing the med ical profession to consider options where illnesses can be managed on a mor e ambulatory basis. The objective of this study was to assess the volume, c haracteristics, and disposition of emergency department (ED) patients who w ere managed in the Short-Stay Emergency Observation Ward (SSEOW). A retrosp ective study of all patients managed in the SSEOW at the Singapore General Hospital (SGH) from July 1 to December 31, 1997 was conducted. The ED case- records of all observed patients were reviewed. Demographic data as well as information on duration of stay, provisional diagnoses, investigations per formed, treatment rendered, and disposition were collected. A total of 114, 586 patients were seen at the ED during the study period. There were 9,126 (7.9%) patients who were observed and 1,756 (19.2% of observed or 1.5% of t otal ED attendance) were subsequently admitted. The median duration of obse rvation was 5.6 +/- 9.2 hours. The hospitalization rate for male and female patients was almost equal (19.2% versus 19.3%) and those 60 years and olde r (3,559 or 39.0%) had the highest hospitalization rate (28.0%). The higher the triage priority, the more likely the patient was to be observed and su bsequently admitted. Most were observed between 2 to 4 hours (3,288 or 36.0 %) and the largest group comprised of those with abdominal complaints (4,11 5 or 45.1%). Patients with alcohol-related problems were observed the longe st (6.7 + 9.8 hours) but had the lowest hospitalization rate (2.6%), The SS EOW allowed a 6.4% savings to direct inpatient admission at SGH. The SSEOW represent a management area for the delivery of short-term and diagnostic c are on an ambulatory basis. It is accessible, safe and effective in reducin g adions. Copyright (C) 2000 by W.B. Saunders Company.