Observation unit admission as an alternative to inpatient admission for trauma activation patients

Utility of an Emergency Department Observation Unit in Providing Care for Patients With Blunt Thoracic Trauma

Background The use of Emergency Department Observation Units (EDOUs) to treat patients with a variety of complaints has grown over recent years. However, the treatment of patients with traumatic injuries in EDOUs is infrequently described. Our study sought to describe the feasibility of treating patients with blunt thoracic trauma in an EDOU in consultation with our trauma and acute care surgery (TACS) team. Together, our Emergency Department (ED) and TACS teams designed a protocol for the treatment of patients with specific blunt thoracic injuries (fewer than three rib fractures, nondisplaced sternal fractures) that we felt would require less than 24 hours of care in a hospital setting. Methods This study is an IRB-approved retrospective analysis comparing two groups before (pre-EDOU) and after (EDOU) the creation of the EDOU protocol, which was implemented in August 2020. Data was collected at a single, Level 1 trauma center with approximately 95,000 annual visits. Similar inclusion and exclusion criteria were used to select patients in both groups. We conducted two-sample t-tests and Chi-square testing to assess for significance. Primary outcomes include length of stay and bounce-back rate. Results A total of 81 patients were included in our data set across both groups. Forty-three patients were included in our pre-EDOU group while 38 patients were treated in our EDOU once the protocol was implemented. Patients in both groups were of similar age, gender and had similar Injury Severity Scores (ISS) ranging from 9 to 14. Hospital length of stay was shorter for the EDOU group (31.5 hours) compared to the pre-EDOU group (36.4 hours) although not statistically significant. When risk stratified by ISS, hospital length of stay did reach statistical significance and was found to be shorter for patients with ISS scores greater than or equal to 9 that were treated in the EDOU (29.1 hours vs. 43.8 hours, p = .028). Both groups had one patient each bounce back for repeat evaluation and additional care. Conclusion This study demonstrates the potential use of EDOUs to treat patients with mild to moderate blunt thoracic injuries. The availability of trauma surgeons for consultation along with ED provider experience may be rate-limiting steps in utilizing observation units to care for trauma patients. Additional research with more participants is needed to determine the impact of implementing such a practice at other institutions.

Care of Traumatic Conditions in an Observation Unit

Patients presenting to the emergency department with certain traumatic conditions can be managed in observation units. The evidence base supporting the use of observation units to manage injured patients is smaller than the evidence base supporting the management of medical conditions in observation units. The conditions that are eligible for management in an observation unit are not limited to those described in this article, and investigators should continue to identify types of conditions that may benefit from this type of health care delivery.

Implementation Analysis of a Nurse-Led Observation Unit

OBJECTIVE

This implementation analysis of a nurse-led observation unit describes the development process and analyzes patients' characteristics, patient satisfaction, and provider perceptions.

BACKGROUND

A nurse-led observation unit was developed to create more inpatient bed capacity and place patients in the clinical area best suited to their needs.

METHODS

Descriptive statistics and content analysis were used for analysis.

RESULTS

The average length of stay of 467 patients was 1.1 days; 68.1% (n = 318) were female. Elective surgery was the most frequent reason for admission. All of the patients rated the observation unit patient feedback survey factors favorably except for noise. All healthcare providers (n = 64) reported that they communicated well with each other and had resources to provide quality care but rated the environment less favorably.

CONCLUSIONS

A nurse-led observation unit was found to be an effective and efficient approach to providing postoperative and postprocedure care, which was generally well received by patients and healthcare providers.

Admission to an Observational Unit Improves Length of Stay for Patients with Mild Traumatic Brain Injuries

Presented at the American College of Surgeons Committee on Trauma 2012 Delaware State Paper Competition and Region 3 Paper Competition (Christiana Care Health System, November 2012 Newark, Delaware).

Deriving a prediction rule for short stay admission in trauma patients admitted at a major trauma centre in Australia

INTRODUCTION

The aim of this study was to derive and internally validate a prediction rule for short stay admissions (SSAs) in trauma patients admitted to a major trauma centre.

METHODS

A retrospective study of all trauma activation patients requiring inpatient admission at a single inner city major trauma centre in Australia between 2007 and 2011 was conducted. Logistic regression was used to derive a multivariable model for the outcome of SSA (length of stay ≤2 days excluding deaths or intensive care unit admission). Model discrimination was tested using area under receiver operator characteristic curve analyses and calibration was tested using the Hosmer-Lemeshow test statistic. Validation was performed by splitting the dataset into derivation and validation datasets and further tested using bootstrap cross validation.

RESULTS

A total of 2593 patients were studied and 30% were classified as SSAs. Important independent predictors of SSA were injury severity score ≤8 (OR 7.8; 95% CI 5.0 to 11.9), Glasgow coma score 14-15 (OR 3.2; 95% CI 1.8 to 5.4), no need for operative intervention (OR 2.2; 95% CI 1.6 to 3.2) and age < 65 years. (OR 1.7; 95% CI 1.2 to 2.6). The overall model had an area under receiver operator characteristic curve of 0.84 (95% CI 0.82 to 0.87) for the derivation dataset. After bootstrap cross validation the area under the curve of the final model was 0.83 (95% CI 0.81 to 0.84).

CONCLUSIONS

We report a prediction rule that could be used to establish admission criteria for a trauma short stay unit. Further studies are required to prospectively validate the prediction rule.

Emergency department observation units and the older patient

An increasing number of emergency departments (EDs) are providing extended care and monitoring of patients in ED observation units (EDOUs). EDOUs can be useful for older adults as an alternative to hospitalization and as a means of risk stratification for older adults with unclear presentations. They can also provide a period of therapeutic intervention and reassessment for older patients in whom the appropriateness and safety of immediate outpatient care are unclear. This article discusses the general characteristics of EDOUs, reviews appropriate entry and exclusion criteria for older adults in EDOUs, and discusses regulatory implications of observation status for patients with Medicare.

Design and application of an information system for the emergency observation room in a Chinese hospital

The emergency observation room (EOR) in a Chinese hospital provides medium-term observation and treatment, as well holding patients who will be admitted to the wards. The operational pattern of the EOR lies between those of the outpatient and inpatient services. We developed a novel information system for the EOR to meet the specific requirements for issuing medication, which includes both order sheets and prescriptions, and tested it in a Grade 3 and Class A hospital. The system reduced the frequency of cashier interactions and the time taken for patients to access their medications, and also reduced the workloads of doctors and other staff members.