The following is a summary of “Effect of increasing emergency department observation volumes on downstream admission rates,” published in the March 2024 issue of Emergency Medicine by Grossman, et al.

For a study, researchers sought to assess the impact of vigorous tracking and provider reviews of one-day hospital admits on using emergency department (ED) observation and subsequent admission rates to address rising ED length of stay and inpatient boarding.

Between September 2020 and May 2021, chart reviews of 24-hour inpatient discharges were conducted at a tertiary care hospital with an annual ED volume of 55,000. Two senior emergency medicine (EM) faculty initiated the reviews to determine suitability for ED observation. Non-punitive email reviews were then conducted with ED-attending providers to encourage evaluation of whether these patients could have benefitted from observation. ED observation patient volumes and subsequent admission rates were analyzed and compared to baseline data from September 2018 to May 2019.

A total of 1,448 reviews were conducted on 24-hour discharges. It correlated with an increase in the utilization of ED observation from 11.77% (95% CI [11.62, 12.31]) of the total ED volume during our control period to 14.21% (95% CI [13.84, 14.58]) during the study period. Additionally, the overall admission rate from ED observation rose from 20.12% (95% CI [18.97, 21.26]) at baseline to 23.80% (95% CI [22.60, 25.00]) during the same periods.

The data indicated that increasing the number of patients placed into observation correlated with a relative increase in admission rates from ED observation. Efforts to expand observation programs may contribute to higher subsequent admission rates. Striking a balance between under- and over-utilization of ED observation is crucial, and expanding observation may serve as a viable solution to address hospital boarding and ED overcrowding.

Reference: sciencedirect.com/science/article/abs/pii/S0735675723006654