The observation unit: A new interface between inpatient and outpatient care

PURPOSE: Observation units for patients who present to emergency department s with chest pain have become common. We describe our 3-year experience wit h a multipurpose observation-unit in which chest pain accounts for only a m inority of patients' presenting clinical syndromes. SUBJECTS AND METHODS: We analyzed the effects of a 12-bed observation unit on inpatient admissions for common clinical syndromes, as well as its overa ll effects on inpatient medical admissions during its first 3 years of oper ation (1996 to 1998) compared with the 3 years preceding its creation (1993 to 1995). RESULTS: Among 7,507 patients admitted to the observation unit in 1996 to 1 998, 6,334 (85%) were discharged home within 23 hours. Total inpatient medi cal admissions fell by a similar number (n = 5,366) during the 3 years of o peration of the observation unit when compared with the 3 preceding years ( 39,569 admissions in 1996 to 1998 versus 44,935 in 1993 to 1995). Analysis of local area trends suggested that the use of the observation unit contrib uted to reduced hospital admissions, rather than vice versa. CONCLUSION: Observation units can serve patients with diverse clinical synd romes and may reduce inpatient admissions. This novel "point of care" deser ves further evaluation.