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Characteristics of Hospital Observation Services: A Society of Cardiovascular Patient Care Survey

Osborne, Anwar MD, MPM; Weston, John MD; Wheatley, Matthew MD; O’Malley, Rachel MD; Leach, George MD; Pitts, Stephen MD, MPH; Schrager, Justin MD, MPH; Holmes, Kay MSA, BSN; Ross, Michael MD

Critical Pathways in Cardiology: June 2013 - Volume 12 - Issue 2 - p 45–48
doi: 10.1097/HPC.0b013e318285c2b9
Original Articles

Introduction: Little is known about the setting in which observation services are provided, or how observation patients are managed in settings such as accredited cardiovascular patient care centers.

Objective: To describe the characteristics of observation services in accredited Cardiovascular Patient Care hospitals, or those seeking accreditation.

Methods: This is a cross-sectional survey of hospitals either accredited by the Society of Cardiovascular Patient Care, or considering accreditation in 2010. The survey was a web-based free service linked to an e-mail sent to Cardiovascular Patient Care coordinators at the respective institutions. The survey included 17 questions which focused on hospital characteristics and observation services, specifically management, settings, staffing, utilization, and performance data.

Results: Of the 789 accredited hospitals, 91 hospitals (11.5%) responded to the survey. Responding hospitals had a median of 250 inpatient beds (interquartile range [IQR] 277), 32.5 emergency department (ED) beds or hall spots, with an average annual ED census of 41,660 (IQR 30,149). These hospitals had an average of 8 (IQR 9) observation unit beds whose median length of stay (LOS) was 19 hours (IQR 8.1), with a discharge rate of 89.1% (IQR 15). There was an average of 1 observation bed to 3.8 ED beds. Observation units were most commonly administered by emergency medicine (48.5%), but staffed by a broad spectrum of specialties. Nonemergency medicine units had longer LOSs, which were not significant. Most common conditions were chest pain and abdominal pain.

Conclusions: Accredited chest pain centers have observation units whose LOSs and discharge rates are comparable to prior studies with utilization patterns that may serve as benchmarks for similar hospitals.

From the Emory University, Society of Cardiovascular Patient Care, Atlanta, GA.

Kay Holmes is employed by the Society of Cardiovascular Patient Care. Michael Ross is a past president Society of Cardiovascular Patient Care, Anwar Osborne is a member of the Society of Cardiovascular Patient Care.

Reprints: Anwar Osborne, MD, MPM, Department of Emergency Medicine, Emory University School of Medicine, 531 Asbury Circle Annex, Atlanta, GA. E-mail:

© 2013 by Lippincott Williams & Wilkins