Observation units are a growing destination for many patients with a variety of diagnoses. The elderly represent a large part of the observation population, which will likely grow as baby-boomers age. Those of advanced age can have different medical and social needs than their younger cohort, so understanding their prevalence and expected outcomes in the observation units is key for resource deployment and even patient selection for the unit. We sought to identify the volume of patients of increasing age and their eventual dispositions after placement in the observation unit at our institution.
The study was conducted a retrospective review of patients from a 35-bed observation unit at an urban tertiary referral center, which is primarily hospitalist-run with addition surgical and post-procedural patients. All patients seen in the observation unit by any provider from September 2014 through August 2015 were included in the analysis. Basic demographic data was collected for all patients at the time of observation encounter. Observation unit outcomes included disposition destination directly from the unit, admission to inpatient, return to the observation unit within 15 days, time in observation, and volume of consults ordered within the electronic medical record. Patients were divided by decade of age at presentation for comparisons.
Observation unit encounters during the study period totaled 6320 with an average age of 58.0 ±17.9 years. Volumes of observation encounters by patient age, proportion of discharges to a skilled nursing facilities (SNFs), and consult order volume are summarized in Table 1. Rates of return to the observation within 15 days of discharge was relatively similar between all decades, with a range only 12-15%. Hospitalists were primary providers of 76% of patients ≥50 years old compared to only 58% for those <50 years of age (p<0.001). Progressively increasing rates of inpatient admissions and lengths of stay by decade are seen in Figure 1.
The elderly represented over a quarter of observation encounters at our institution. With advancing age there was a clear trend toward, higher volumes of consults, longer lengths of stay, greater dispositions to SNFs, and admissions. This represents a large need for discharge assistance from ancillary services and case management that may not be available in all observation units, and therefore in those circumstances patients of significantly more advanced age may be more appropriate for admission.