I recently took care of a woman in her 50s that came to our emergency department (ED) complaining of chest pain. The pain had started shortly before arriving in the ED but within minutes, we performed a battery of tests, treated her pain, and gave her an aspirin. Still concerned about heart disease being the cause of her pain, I observed her overnight in our EDs observation unit and completed additional tests including a cardiovascular stress test. She was able to leave our ED within 15 hours with reassurance that her chest pain was likely benign. Only a few years ago, this patient would have required a time consuming and costly admission to the hospital.
EDs are set up to efficiently treat and manage chest pain. The use of observation ED facilities has enhanced the EDs ability to provide patients with additional services for up to 24 hours while preventing costly admissions to the hospital. A 2013 research study in Health Affairs that studied ED observation units demonstrated decreased length of stays, decreased admission rates, and a projected cost saving of up to $8.5 billion U.S. dollars annually. Observation facilities can cover a variety of diagnosis.
For example, Beth Israel Deaconess Medical Center, one of the Harvard Medical School teaching hospitals, has an observation ED facility that covers a range of diagnosis including chest pain, asthma attacks, allergic reactions, seizures, gastrointestinal bleeding, infections, as well as many other conditions that are typically admitted to the hospital. These observation facilities often “feel” like inpatient hospital units with private beds. Observation based EDs represent an innovative design that has already shown value to patients and hospital systems.
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