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Observation Medicine

In 2003, the Emergency Department (ED) of Northwestern Memorial Hospital (NMH) opened the Emergency Department Observation Unit (EDOU).  This unit has 24 monitored beds located on the mezzanine of the Feinberg Pavilion, directly above the ED.  Patients who require prolonged observation, further diagnostic evaluation and treatment, and whose needs are likely to be met in 24 hours or less are candidates for the EDOU.  Observation units have been clearly shown to decrease unnecessary admissions, expedite patient care, prevent inappropriate patient release, decrease costs, and improve patient satisfaction and outcomes. 

The EDOU has taken over the role of the former Chest Pain Evaluation Center (CPEC), which treated the lowest risk chest pain patients.  By contrast, the EDOU has expanded beyond these lowest risk chest pain patients, taking on the intermediate risk patient, thereby freeing up the Cardiac Care Unit (CCU) and inpatient telemetry beds for acute patients.  In addition, the EDOU has established a protocol for syncope, which has enabled half of former syncope admissions to be monitored in the EDOU instead of in inpatient telemetry.  We are currently finalizing protocols for congestive heart failure, atrial fibrillation, and post-conversion supraventricular tachycardia, the implementation of which should further unload inpatient telemetry beds.  If appropriately screened, a variety of other diagnoses have been managed successfully in the EDOU, including drug overdose, pneumonia, epistaxis, hypertensive urgencies, viral meningitis, diverticulitis, refractory headache, concussion, vertigo, and uncontrolled diabetes.

Although 60% of EDOU admissions have cardiac diagnoses, there has been a wide spectrum of emergent conditions that have proven appropriate for the observation unit.  These diagnoses include asthma, deep venous thrombosis, renal colic, dehydration/gastroenteritis, nonspecific abdominal pain, allergic reactions,cellulitis, and pyelonephritis. 

With hospital census often at full capacity, the EDOU has had a significant   impact on inpatient telemetry bed availability.  In addition, the efficient throughput of patients in the ED has helped alleviate ED overcrowding and excessive waiting times.  We now have a dedicated bed in the ED for the evaluation of chest pain (Acute Coronary Syndrome Evaluation Space) resulting in a large proportion of patients going directly to the EDOU after a brief ED work up, further facilitating patient care: throughput and satisfaction.

An important goal of the EDOU is expedited care by carefully conceived protocols. The EDOU patients have regular evaluations by ED physicians and nurses.  In addition, we have resident coverage and a nurse practitioner to evaluate, monitor, and quickly disposition patients.   Diagnostic testing is done with similar urgency.  We have observed that inpatient stays of 1-2 days can be compressed to less than 24 hours in the EDOU, with a resultant decrease in cost, but more importantly enhancement of patient satisfaction and quality of care.  As testimony to this, our satisfaction scores have consistently exceeded 90%.

In planning for the EDOU, we developed protocols for various diagnoses appropriate for the unit.  We began with an emphasis on chest pain and a few other diagnoses, and currently have expanded to 12 protocols, anticipating over 30 protocols to be formalized over time.  We have worked actively with nursing regarding issues of staffing, orders, and patient flow; we anticipate our unit as among the first to go online with physician order entry and charting.  We have participated in national organizations that are at the forefront of observation medicine, including the Observation Medicine section of the American College of Emergency Physicians (ACEP) and the National Society of Chest Pain Centers.  EDOU Co-Director, Daniel Stone, MD, is currently the President of the Observation Section of ACEP with fellow Co-Director, David Zull, MD, as the Secretary and Newsletter Editor.

The EDOU provides an ideal environment for data acquisition, thereby facilitating total quality management, utilization review, and clinical research which is currently underway.  We have developed criteria for total quality management and utilization review in the EDOU to improve patient care and track outcomes, and we report quarterly to the Emergency Department Quality Management (EDQM) Committee.

The EDOU is having a lasting impact on the way medicine is practiced at NMH.  The expedited, efficient care of patients in the EDOU, the increased inpatient bed availability (especially monitored beds), the improvement in ED waiting times and length of stays, the expansion of research for the Department, and the improvement in patient outcomes and satisfaction have all resulted in substantial improvements in daily patient care.  Further improvements will continue in the years to come, based on our strong commitment to patient care.   

For questions about our department's observation unit, please contact directors, Dr. David Zull and Dr. Daniel Stone.

For more information about ongoing research in the observation unit, please click here for our research page.

This page last updated on Wed May 10, 2006 8:49 AM