ArticlePloS one2011
Use of observation care in US emergency departments, 2001 to 2008.
Article in PloS one, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 57 papers.
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Who cites it
57 citing papers in PubMed.
- Condition-Specific Protocols Used in the Emergency Department Observation Unit: A Scoping Review.Journal of the American College of Emergency Physicians open · 2026Review
- Validation of a 0/2-Hour Point-Of-Care High Sensitivity Troponin Algorithm: A Multisite US Study.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2026Article
- Diagnostic Yield of Transthoracic Echocardiography Among US Emergency Department Observation Unit Patients Evaluated for Transient Ischemic Attack.Critical pathways in cardiology · 2026Observational
- Trends in Observation Care and the Growth of Dedicated Emergency Department Observation Units: An Analysis of the National Hospital Ambulatory Medical Care Survey, 2007-2022.Journal of the American College of Emergency Physicians open · 2025Article
- Cost-effectiveness of early noninvasive cardiac testing for suspected acute coronary syndrome.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2025Article
- Are There Benefits to Observation Units in the Emergency Departments: A Narrative Review.Journal of clinical medicine · 2025Review
- A Quality Improvement Initiative to Decrease Hospital Admission for Skin and Soft Tissue Infections From an Observation Unit.Journal of the American College of Emergency Physicians open · 2025Article
- Association of Observation Stays with Clinical Outcomes and Costs in Medicare: An Instrumental Variable Analysis.Journal of general internal medicine · 2025Article
- Trends in healthy days at home for Medicare beneficiaries using the emergency department.Journal of the American Geriatrics Society · 2023Article
- Returns After Discharge From the Emergency Department Observation Unit: Who, What, When, and Why?The western journal of emergency medicine · 2023Article
- Outcomes of Patients Placed in an Emergency Department Observation Unit of a Comprehensive Cancer Center.JCO oncology practice · 2022Observational
- Higher Emergency Physician Chest Pain Hospitalization Rates Do Not Lead to Improved Patient Outcomes.Circulation. Cardiovascular quality and outcomes · 2021Article
- The utility of emergency department physical therapy and case management consultation in reducing hospital admissions.Journal of the American College of Emergency Physicians open · 2020Article
- Impact of ED Organization with a Holding Area and a Dedicated Team on the Adherence to International Guidelines for Patients with Acute Pulmonary Embolism: Experience of an Emergency Department Organized in Areas of Intensity of Care.Medicines (Basel, Switzerland) · 2020Article
- Nonspecific chest pain and hospital revisits within 7 days of care: variation across emergency department, observation and inpatient visits.BMC health services research · 2020Article
- Emergency Department Visits and Subsequent Hospital Admission Trends for Patients with Chest Pain and a History of Coronary Artery Disease.Cardiology and therapy · 2020Article
- Role of a Brief Intensive Observation Area with a Dedicated Team of Doctors in the Management of Acute Heart Failure Patients: A Retrospective Observational Study.Medicina (Kaunas, Lithuania) · 2020Observational
- Automated Identification and Extraction of Exercise Treadmill Test Results.Journal of the American Heart Association · 2020Article
- Changes in Emergency Department Care Intensity from 2007-16: Analysis of the National Hospital Ambulatory Medical Care Survey.The western journal of emergency medicine · 2020Article
- Study protocol for IMAGE: implementing multidisciplinary assessments for geriatric patients in an emergency department observation unit, a hybrid effectiveness/implementation study using the Consolidated Framework for Implementation Research.Implementation science communications · 2020Article
Corrections and comments
- Erratum issued
Authors and funding
6 authors.
Funding
Abstract
backgroundObservation care is a core component of emergency care delivery, yet, the prevalence of emergency department (ED) observation units (OUs) and use of observation care after ED visits is unknown. Our objective was to describe the 1) prevalence of OUs in United States (US) hospitals, 2) clinical conditions most frequently evaluated with observation, and 3) patient and hospital characteristics associated with use of observation.
methodsRetrospective analysis of the proportion of hospitals with dedicated OUs and patient disposition after ED visit (discharge, inpatient admission or observation evaluation) using the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2001 to 2008. NHAMCS is an annual, national probability sample of ED visits to US hospitals conducted by the Center for Disease Control and Prevention. Logistic regression was used to assess hospital-level predictors of OU presence and polytomous logistic regression was used for patient-level predictors of visit disposition, each adjusted for multi-level sampling data. OU analysis was limited to 2007-2008.
resultsIn 2007-2008, 34.1% of all EDs had a dedicated OU, of which 56.1% were under ED administrative control (EDOU). Between 2001 and 2008, ED visits resulting in a disposition to observation increased from 642,000 (0.60% of ED visits) to 2,318,000 (1.87%, p<.05). Chest pain was the most common reason for ED visit resulting in observation and the most common observation discharge diagnosis (19.1% and 17.1% of observation evaluations, respectively). In hospital-level adjusted analysis, hospital ownership status (non-profit or government), non-teaching status, and longer ED length of visit (>3.6 h) were predictive of OU presence. After patient-level adjustment, EDOU presence was associated with increased disposition to observation (OR 2.19).
conclusionsOne-third of US hospitals have dedicated OUs and observation care is increasingly used for a range of clinical conditions. Further research is warranted to understand the quality, cost and efficiency of observation care.
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