Peacock Frank, Beckley Philip, Clark Carol, Disch Maghee, Hewins Kelly, Hunn Donna, Kontos Michael C, Levy Phillip, Mace Sharon, Melching Kay Styer, Ordonez Edgar, Osborne Anwar, Suri Pawan, Sun Benjamin, Wheatley Matt
From the *Baylor College of Medicine, Ben Taub Hospital, Houston, TX; †Society of Cardiovascular Patient Care, Dublin, OH; ‡Beaumont Health System, Royal Oaks, MI; §Virginia Commonwealth University Medical Center, Richmond, VA; ¶Wayne State University School of Medicine, Detroit, MI; ‖Cleveland Clinic, Cleveland, OH; **Emory University School of Medicine, Atlanta, GA; and ††Oregon Health & Science University, Portland, OR.
Crit Pathw Cardiol. 2014 Dec;13(4):163-98. doi: 10.1097/HPC.0000000000000033.
Observation Services (OS) was founded by emergency physicians in an attempt to manage "boarding" issues faced by emergency departments throughout the United States. As a result, OS have proven to be an effective strategy in reducing costs and decreasing lengths of stay while improving patient outcomes. When OS are appropriately leveraged for maximum efficiency, patients presenting to emergency departments with common disease processes can be effectively treated in a timely manner. A well-structured observation program will help hospitals reduce the number of inappropriate, costly inpatient admissions while avoiding the potential of inappropriate discharges. Observation medicine is a complicated multidimensional issue that has generated much confusion. This service is designed to provide the best possible patient care in a value-based purchasing environment where quality, cost, and patient satisfaction must continually be addressed. Observation medicine is a service not a status. Therefore, patients are admitted to the service as outpatients no matter whether they are placed in a virtual or dedicated observation unit. The key to a successful observation program is to determine how to maximize efficiencies. This white paper provides the reader with the foundational guidance for observational services. It defines how to set up an observational service program, which diagnoses are most appropriate for admission, and what the future holds. The goal is to help care providers from any hospital deliver the most appropriate level of treatment, to the most appropriate patient, in the most appropriate location while controlling costs.
观察服务（OS）由急诊医生创立，旨在解决美国各地急诊科面临的“住院难”问题。结果表明，观察服务是一种有效的策略，既能降低成本、缩短住院时间，又能改善患者预后。当观察服务得到合理利用以实现效率最大化时，患有常见疾病的急诊科患者能够得到及时有效的治疗。一个结构完善的观察项目将有助于医院减少不恰当、高成本的住院人数，同时避免不恰当出院的可能性。观察医学是一个复杂的多维度问题，引发了诸多困惑。这项服务旨在基于价值购买的环境中提供尽可能优质的患者护理，在这种环境下，质量、成本和患者满意度必须持续得到关注。观察医学是一项服务而非一种状态。因此，无论患者被安置在虚拟观察单元还是专用观察单元，他们作为门诊患者被纳入这项服务。成功的观察项目的关键在于确定如何实现效率最大化。本白皮书为读者提供观察服务的基础指南。它定义了如何建立观察服务项目、哪些诊断最适合入院以及未来的发展方向。目标是帮助任何医院的护理人员在控制成本的同时，在最合适的地点为最合适的患者提供最合适水平的治疗。
