• Jennifer L Wiler, Michael A Ross, and Adit A Ginde.
• Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, USA. jenniferwiler@ucdenver.edu
• Acad Emerg Med. 2011 Sep 1;18(9):959-65.

ObjectivesThe objective was to describe patient and facility characteristics of emergency department (ED) observation services in the United States.MethodsThe authors analyzed the 2007 National Hospital Ambulatory Medical Care Survey (NHAMCS). Characteristics of EDs with observation units (OUs) were compared to those without, and patients with a disposition of ED observation were compared to those with a "short-stay" (<48 hour) hospital admission. Results are descriptive and without formal statistical comparisons for this observational analysis.ResultsAn estimated 1,746 U.S. EDs (36%) reported having OUs, of which 56% are administratively managed by ED staff. Fifty-two percent of hospitals with ED-managed OUs are in an urban location, and 89% report ED boarding, compared to 29 and 65% of those that do not have an OU. The admission rate is 38% at those with ED-managed OUs and 15% at those without OUs. Of the 15.1% of all ED patients who are kept in the hospital following an ED visit, one-quarter are kept for either a short-stay admission (1.8%) or an ED observation admission (2.1%). Most (82%) ED observation patients were discharged from the ED. ED observation patients were similar to short-stay admission patients in terms of age (median = 52 years for both, interquartile range = 36 to 70 years), self-pay (12% vs. 10%), ambulance arrival (37% vs. 36%), urgent/emergent triage acuity (77% vs. 74%), use of ≥1 ED medication (64% vs.76%), and the most common primary chief complaints and primary diagnoses.ConclusionsOver one-third of U.S. EDs have an OU. Short-stay admission patients have similar characteristics as ED observation patients and may represent an opportunity for the growth of OUs.© 2011 by the Society for Academic Emergency Medicine.

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