Factors affecting patients in observation unit of emergency department, Maharaj Nakhon Si Thammarat hospital had to be moved to other inpatient department
Keywords:
observation unit, triage levelAbstract
Background: Observation unit is suitable for patients who come to the emergency room, need a short period of time to treat or monitor symptoms. Patients who are selected for treatment should be an uncomplicated diseases or symptoms that can be discharge within 24 hours, but some patients are found to be worse off, causing them to move to IPD . Some have serious complications.
Objective: To study the factors affecting patients who have a short-term observation unit in the emergency medicine department, had to be moved to inpatient departments.
Materials and Methods: A retrospective descriptive study by retrospective chart review of 196 patients admitted to observation unit were transferred to IPD from April 19, 2019 to April 19, 2020.
Results: During the study period, there were 1,086 patients who have admitted in observation unit, 196 patients (18%) subsequent transferred from OU to IPD. The factors that affect the subsequent transfer of patients from OU to IPD are patient severity (Triage level: emergency and urgency) fever unspecified, abdominal pain unspecified and dyspepsia (p=0.001, 0.022, 0.043 and 0.021, respectively). The most common cause are fever unspecified (30.1%), acute gastroenteritis (18.4%) and abdominal pain unspecified (13.8%).
Conclusions: Triage level emergency and urgency, fever unspecified, abdominal pain unspecified and dyspepsia are the factors that affects patients who are treated in short-term observation unit, and subsequently moved to the inpatient department.
References
2. Gururaj VJ, Allen JE, Russo RM. Short stay in an outpatient department. An alternative to hospitalization. Am J Dis Child. 1972;123:128-32.
3. Yealy DM, De Hart DA, Ellis G, et al. A survey of observation units in the United States. Am J Emerg Med. 1989;7:576-80.
4. Wiler JL, Ginde AA. 440: National Study of Emergency Department Observation Services. Ann Emerg Med. 2010;56:S142.
5. Mace SE, Graff L, Mikhail M, et al. A national survey of observation units in the United States. Am J Emerg Med. 2003;21:529-33.
6. Jelinek GA, Galvin GM. Observation wards in Australian hospitals. Med J Aust. 1989;151:80, 2-3.
7. Aggarwal P, Wali JP, Ranganathan S, et al. Utility of an observation unit in the emergency department of a tertiary care hospital in India. Eur J Emerg Med. 1995;2:1-5.
8. Lateef F, Anantharaman V. The short-stay emergency observation ward is here to stay. Am J Emerg Med. 2000;18:629-34.
9. Liu Y, Zhang B, Fu W, et al. A preliminaryepidemiological study of the patient population visiting an urban ED in the Republic of China. Am J Emerg Med. 1994;12:247-9.
10. Carpentier F, Guignier M, Eytan VL. [Short emergency hospitalization]. Therapie. 2001;56:151-5.
11. Portela MC, Schramm JM, Pepe VL, et al. [Algorithm for establishing hospital admittance data based on the hospital information system in the Brazilian Unified Health System]. Cad Saude Publica. 1997;13:771-4.
12. Goodacre SW. Role of the short stay observation ward in accident and emergency departments in the United Kingdom. J Accid Emerg Med. 1998;15:26-30.
13. Gouin S, Macarthur C, Parkin PC, et al. Effect of a pediatric observation unit on the rate of hospitalization for asthma. Ann Emerg Med. 1997;29:218-22.
14. Hadden DS, Dearden CH, Rocke LG. Short stay observation patients: general wards are inappropriate. J Accid Emerg Med. 1996;13:163-5.
15. Observatinal unit. ใน นายแพทย์ชาติชาย คล้ายสุบรรณ ,บรรณาธิการ. คู่มือแนวทางการจัดบริการห้องฉุกเฉิน. กรุงเทพมหานคร: สามชัย 2017. 2561. หน้า 68-69.
16. Hostetler B, Leikin JB, Timmons JA, et al. Patterns of use of an emergency department-based observation unit. Am J Ther. 2002;9:499-502.
17. Ross MA, Compton S, Richardson D, et al. The use and effectiveness of an emergency department observation unit for elderly patients. Ann Emerg Med. 2003;41:668-77.
18. Ross MA, Davis B, Dresselhouse A. The role of an emergency department observation unit in a clinical pathway for atrial fibrillation. Crit Pathw Cardiol. 2004;3:8-12.
19. Medicare Benefit Policy Manual. Chapter 6—Hospital ServicesCovered Under PartB.2013.http://www.cms.gov/RegulationsandGuidance/Guidance/Manuals/downloads/bp102c06.pdf. Accessed 17 Oct 2013.
20. Mace SE, Graff L, Mikhail M, et al. A national survey of observation units in the United States. Am J Emerg Med. 2003;21:529-33.
21. Hostetler B, Leikin JB, Timmons JA, et al. Patterns of use of an emergency department-based observation unit. Am J Ther. 2002;9:499-502.
22. Ross MA, Compton S, Richardson D, et al. The use and effectiveness of an emergency department observation unit for elderly patients. Ann Emerg Med. 2003;41:668-77.
23. Brillman J, Mathers-Dunbar L, Graff L, Joseph T, Leikin JB, Schultz C, et al. Management of observation units. American College of Emergency Physicians.Ann Emerg Med. 1995 Jun;25(6):823-30
24. Mace SE. Resuscitations in an observation unit. J Qual Clin Pract. 1999;19:155-64.
25. Jones PF. Active observation in management of acute abdominal pain in childhood. BrMed J. 1976;2:551-3.
26. Graff L, Radford MJ, Werne C. Probability of appendicitis before and after observation. Ann Emerg Med. 1991;20:503-7.
Downloads
Published
How to Cite
Issue
Section
License
เนื้อหาและข้อมูลในบทความที่ลงตีพิมพ์ในมหาราชนครศรีธรรมราชเวชสาร ถือเป็นข้อคิดเห็นและความรับผิดชอบของผู้เขียนบทความโดยตรงซึ่งกองบรรณาธิการวารสาร ไม่จำเป็นต้องเห็นด้วย หรือร่วมรับผิดชอบใด ๆ
บทความ ข้อมูล เนื้อหา รูปภาพ ฯลฯ ที่ได้รับการตีพิมพ์ในมหาราชนครศรีธรรมราชเวชสาร ถือเป็นลิขสิทธิ์ของมหาราชนครศรีธรรมราชเวชสาร หากบุคคลหรือหน่วยงานใดต้องการนำทั้งหมดหรือส่วนหนึ่งส่วนใดไปเผยแพร่ต่อหรือเพื่อกระทำการใด จะต้องได้รับอนุญาตเป็นลายลักษณ์อักษรจากวารสารมหาราชนครศรีธรรมราชเวชสาร ก่อนเท่านั้น
