DR.AZIZUL HAFIZ B.

ABDUL
AZIZ
TRAUMA & EMERGENCY
DEPARTMENT HOSP TELUK
INTAN
OBSERVATIONAL MEDICINE
- The Concept- Initial
Treatment
OBSERVATIONAL MEDICINE
-The Concept-
Economic pressures for efficiency in health
care
Difficult to rapidly diagnose with presentation
at Emergency Department.
OBSERVATIONAL MEDICINE
- The Concept- Initial
Initial Treatment
Treatment
 OBSERVATIONAL MEDICINE TRADITIONAL
ED

- The Concept-
Observation units
Lasts 2-3
hours
Extension of ED services •Performs a
history and
Improve patient care by continuing physical
the evaluation and management examination
and orders
of selected ED patients who would laboratory and
otherwise require admission radiologic
Short-term services for up to 24 hrstests
When the test
results return,
the physician
either admits
the patient to
the hospital or
discharges the
OBSERVATIONAL MEDICINE
- The Concept-
Observation orders
Clinical impression
Reason for observation
Therapeutic evaluation plan
Expected outcome criteria and time frame for
disposition
Physician responsible for the patient’s care
and disposition
 OBSERVATIONAL MEDICINE
- The History-
 Observation has always been a fundamental aspect of how a
physician cares.

 The early healers of Babylonia and Egypt documented

observations of how diseases seemed to progress as early as
1700 BC

 However, it was in 410 BC Hippocrates, developed a more

critical approach to medicine based on observation and
experience which was recorded in the Hippocratic corpus,
became the foundation of how medicine is still practiced today.
(Michael A. Ross, MD, FACEP, Louis G. Graff IV, MD, FACE. PPRINCIPLES OF
OBSERVATION MEDICINE EMERGENCY OBSERVATION MEDICINE 0733-8627/01)
OBSERVATIONAL MEDICINE
-The Role-
Relative to traditional admission, studies have
shown this alternative to have several
beneficial health care outcomes:
 Improved patient satisfaction
 Lower health care costs
 Shorter length of stays
 Improved use of hospital resources
 Less diagnostic uncertainty
OBSERVATIONAL MEDICINE
-The Role-
Lower health care costs
Try to limit costs by preventing complications and
prolonged hospitalizations.
The efficiency which results from use of
such units may improve bed capacity in
individual hospitals and also provide great
national cost savings as care is delivered
safely in less time with use of fewer
resources. Jason D. Napolitano Inderpreet Saini Observation Units: Definition,
,

History, Data, Financial Considerations, and Metrics. Volume 2, Issue 1 , pp 1-8

OBSERVATIONAL MEDICINE
-Limit
The Cases-
to patient specifically deemed appropriate for
short-term evaluation and the therapy (up to 24
hours).
 Chest pain .
 Atrial fibrillation.
 Hypersmolar non-ketotic state or diabetic ketoacidosis
(uncomplicated).
 Acute asthmatic attack.
 Acute exacerbation of chronic lung disease.
 Uncontrolled hypertension.
 Drug reactions.
 Allergic reactions.
 Dehydration requiring intravenous repletion (e.g.,
secondary to vomiting, diarrhea, anorexia, etc.)
OBSERVATIONAL MEDICINE
- The Cases-(cont)
 Unidentified animal bite.
 Short term therapy such as seizure disorder
requiring anticonvulsant loading, sickle cell pain
crisis, transfusion of blood.
 Psychosocial need, i.e. alcohol intoxication,
depression, psychosis, social disposition problems
 Abdominal pain suggesting an acute abdominal
process, but not readily defined.
 Gastrointestinal bleeding of uncertain nature of
significance, etc.
 Infections, requiring short-term parenteral antibiotic
therapy (e.g., pneumonia, cellulites, urinary tract
infection)
OBSERVATIONAL MEDICINE
-The
 Benefits-
All types of assessment/admission wards seem to
have advantages over traditional admission to a
general hospital ward.
Most articles suggest that these wards improve
patient satisfaction, are safe, decrease the length
of stay, provide earlier senior involvement, reduce
unnecessary admissions, and may be particularly
useful in certain diagnostic groups.
Observation wards may produce cost savings
largely relating to the length of stay in such a unit.
 M W Cooke, J Higgins, P Kidd Use of emergency observation and assessment wards: a
systematic literature review. .Am J Emerg Med 2002;7:576–80.
OBSERVATIONAL MEDICINE
a CPU located in the emergency department can
-The
be usedBenefits-
to identify patients with intermediate-risk
unstable angina who can be safely discharged
rather than admitted to the hospital.
45.8% reduction in the rate of hospital admission
for patients with intermediate-risk unstable angina
 no increase in the rate of adverse events after a
median stay in the CPU of 9.2 hours.
(Michael E. Farkouh, M.D., Peter A. Smars, M.D., Guy S. Reeder, M.D., Alan R. Zinsmeister,
Ph.D., Roger W. Evans, Ph.D., Thomas D. Meloy, M.D., Stephen L. Kopecky, M.D., Marvin
Allen, M.D., Thomas G. Allison, Ph.D., Raymond J. Gibbons, M.D., and Sherine E. Gabriel,
M.D. A Clinical Trial of a Chest-Pain Observation Unit for Patients with Unstable Angina.
N Engl J Med 1998; 339:1882-1888December 24, 1998)