DR.AZIZUL HAFIZ B.

ABDUL
AZIZ
TRAUMA & EMERGENCY
DEPARTMENT HOSP TELUK
INTAN

OBSERVATIONAL MEDICINE
- The ConceptInitial
Treatment

OBSERVATIONAL MEDICINE
-The Concept-

Economic pressures for efficiency in health

care
Difficult to rapidly diagnose with presentation
at Emergency Department.

OBSERVATIONAL MEDICINE
- The ConceptInitial
Initial
Treatment

Treatment

OBSERVATIONAL MEDICINE
- The Concept-

TRADITIONAL
ED
Lasts 2-3
Observation units
hours
Performs a
Extension of ED services
history and
Improve patient care by continuing physical
examination
the evaluation and management
and orders
of selected ED patients who would laboratory and
radiologic
otherwise require admission
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 patients 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 RoleLower 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. JasonD.Napolitano InderpreetSaini Observation Units: Definition,
,

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

OBSERVATIONAL MEDICINE
to patient
specifically deemed appropriate for
-Limit
The
Casesshort-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;7:57680.

OBSERVATIONAL
MEDICINE
a CPU located in the emergency department can
be usedBenefitsto identify patients with intermediate-risk
-The
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)