• Margarita E Pena, James M Fox, Anthony C Southall, Robert B Dunne, Susan Szpunar, Stephen Kler, and Robert B Takla.
• St. John Hospital and Medical Center, Dept. of Emergency Medicine, Detroit, MI 48236, USA.
• Am J Emerg Med. 2013 Jul 1;31(7):1042-6.

ObjectiveTo compare efficiency and cost-effectiveness of an observation unit (OU) when managed as a closed unit vs an open unit.MethodsThis observational, retrospective study of a 30-bed OU compared three time periods: Nov 2007 to Aug 2008 (period 1), Nov 2008 to Aug 2009 (period 2) and Nov 2010 to Aug 2011 (period 3). The OU was managed and staffed by non-emergency department physicians as an open unit during period 1, and a closed unit by emergency department physicians during periods 2 and 3.ResultsOU volume was greatest in period 3 (1 vs 3, 95% CI -235.8 to -127.9; 2 vs 3, 95% CI -191.9 to -84.095%). Periods 2 and 3 had shorter lengths of stay for discharged (1 vs 2, 95% CI -6.6 to 1.7; 1 vs 3, 95% CI -8.1 to -3.1) and admitted (1 vs 2, 95% CI -11.4 to -8.6; 1 vs 3, 95% CI -11.8 to -9.0) patients, less admission rates (P < .001), and less 30-day all cause admission rates after discharge (P < .0001). Cost was less during periods 2 and 3 for direct (1 vs 2, 95% CI -392.5 to -305.9; 1 vs 3, 95% CI -471.4 to -388.4), indirect (1 vs 2, 95% CI -249.5 to - 199.8; 1 vs 3, 95% CI -187 to-139.4) and total cost (1 vs 2, 95% CI -640.7 to -507; 1 vs 3, 95% CI -657.2 to -529).ConclusionThe same OU was more efficient and cost-effective when managed as a closed unit vs an open unit.Copyright © 2013 Elsevier Inc. All rights reserved.

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