Effectiveness of a multipurpose observation unit: before and after study

Abstract

Background: The clinical efficacy of multipurpose observation units has not been assessed in comparative studies. A study was undertaken to analyse the effects of the adoption of clear criteria of admission, clinical pathways and time limits together with the strengthening of clinical supervision and dedicated staff on the performance of a short observation unit (SOU).

Methods: In the period from 1 January to 26 March 2007, the rates of SOU utilisation, length of observation, consumption of resources during observation (diagnostic tests and specialist consultations), rates of hospitalisation and adverse events were measured. Reattendances at the emergency department (ED) within 3 months of discharge were also analysed. Patients admitted to the SOU during the same period in 2006 acted as controls.

Results: Compared with 2006, more patients were admitted to the SOU from the ED (8.8% vs 4.5%, p<0.01) where they had spent less time (mean (SD) 13.8 (11.6) h vs 23.0 (13.4) h, p<0.01). Despite the reduction in the length of stay, case mix standardised rates of hospitalisation were not significantly increased (28.9% vs 26.2%). Consultations and radiological investigations were reduced (32.4% vs 40.2%, p<0.05; and 34.1% vs 45.3%, p<0.01, respectively). Adverse events during the observation period or after hospitalisation were exceptionally rare. The short observation of intestinal obstruction, upper gastrointestinal bleeding without endoscopy, chronic obstructive pulmonary diseases, pneumonia or acute heart failure gave questionable benefits since they had high rates of hospitalisation. During the 3 months after discharge from the SOU, fewer patients returned to the ED (16.3% vs 27.2% for all causes, p<0.01; 9.3% vs 14.4% for related causes, p<0.05) and hospitalisation was necessary in fewer cases (1.7% vs 4.3% for all causes, p<0.05) while re-admissions to the SOU remained unchanged (8.7% vs 8.2%, p = NS).

Conclusion: Brief observation in the ED draws a clear benefit from proper organisation and the adoption of standardised clinical pathways.