Background: The observation unit functions to care for patients requiring problem focused management for a variety of conditions requiring less than 48 hours of care. Patients are selected based on conditions that will likely resolve in 24 to 36 hours, require care by a specialty service or require monitoring following a procedure. Despite these guidelines, many patients require admission to inpatient services following their placement in observation. Identifying which patients are more likely to require admission from observation to inpatient may assist in resource management.
Methods: The study was completed based on data from an observation unit within an 800-bed urban tertiary referral teaching hospital. The billing database was queried for all patient encounters in the observation unit for a one-year period from September 2014 to August 2015. Patients were split into groups based on admission to inpatient versus discharge from the observation unit. The two groups were analyzed for patient demographics, hours in observation, return to the hospital within 15 days and volume of consults ordered using T-test for continuous variables and chi-square test for categorical variables.
Results: There were a total of 6320 encounters studied with 813 (12.9%) requiring admission to inpatient service from observation. Of the admitted patients, 46% required at least one consult compared to 19.2% in the discharged group (p < 0.01). The average age of transferred patients was 60.5 compared to 57.6 (p < 0.01). Admitted patients were in observation status for an average of 31.2 hours in contrast to 26.7 hours to those not admitted (p < 0.01). The rate of return to the hospital within 15 days was 13.9% and 13.4% in the admitted versus discharged groups, respectively (p = 0.70). There was no significant difference among the groups with regards to gender composition.
Conclusions: Identification of patients better suited for direct admission to inpatient will assist in resource management in the observation unit. Selecting patients for observation that do not require a consult may be beneficial. Additionally, admitted patients were associated with longer lengths of stay in the observation unit suggesting time and resource utilization in arranging admissions. Age may play a role as admitted patients tended to be older, but the significance of which cannot be determined based on our results.