Effect of Internal Medicine Versus Emergency Medicine Staffing of an Observation Unit on Patient Outcomes

Background:

Approximately one-third of hospitals in the United States have observation units, which are increasingly being staffed by internists rather than emergency medicine physicians. However, there is limited understanding of this effect on patient outcomes.  The available literature suggests that this transition may decrease patient length of stay within the observation unit. The objective of this study is to evaluate whether there is a difference in patient outcomes in an observation unit staffed by internal medicine physicians versus emergency medicine physicians.

Methods:

The observation unit in our hospital transitioned from emergency medicine to internal medicine staffing in July, 2015. This is a retrospective study in a single university center comparing patient outcomes during the four months prior to the transition with the four months following the transition. The outcomes metrics included in the analysis are: 1) observation unit length of stay (LOS), 2) percentage of patients admitted, and 3) number of patients returning to the emergency department within 72 hours of observation unit discharge.  The statistical tests used were t-test and chi square.

Results:

A total of 4315 patients were seen in the observation unit during the study time period  (emergency medicine staffing N=2332, internal medicine staffing N=1983). LOS was significantly longer in the observation unit when staffed by internal medicine physicians as opposed to emergency medicine physicians (23.4 vs 20.7 hours, P<0.0001, CI 1.55-3.78). However, there was no statistically significant difference in percentage of patients admitted (31.5% vs. 31.8%, P=0.92). There was also no significant difference in the percentage of patients who returned within 72 hours of discharge (4.4% vs. 4.8%, p=0.56).

Conclusions:

In contrast to prior reports that internal medicine staffing was associated with a decreased LOS in observation units as compared to emergency medicine physician staffing, we found an increase in LOS under internal medicine staffing. Despite the longer period of observation, no change was found in the percent of patients admitted or in the number of patients who returned to the emergency department within 72 hours of observation unit discharge. The increased LOS may reflect different management styles between the two specialties. This may have implications for hospital throughput and is an appropriate area for further study.