Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA; Neil Hodgson Woodruff School of Nursing, Emory University, USA.
Am J Emerg Med. 2024 Oct;84:59-67. doi: 10.1016/j.ajem.2024.07.039. Epub 2024 Jul 26.
The benefit of virtual emergency department observation unit (EDOU) care relative to traditional observation care in an inpatient bed is unknown.
To determine if virtual observation care in an EDOU is associated with improved length of stay, cost, inpatient admission rate, and adverse events relative to traditional observation care in non-observation unit (NOU) inpatient bed.
This is a retrospective observational cohort study of observation patients managed over 24 months in two urban teaching hospitals. Following an ED visit, observation care occurred in a virtual-EDOU or NOU inpatient setting based on bed availability, physician discretion, and observation guidelines. Primary outcomes were length of stay, total cost, inpatient admission rate, and adverse events (death or ICU admission). Hospital cost and clinical databases were used. Analysis with a doubly-robust regression with entropy balancing and propensity scores was used to control for subgroup differences.
30,191 observation patients were divided into 13,753 NOU patients and 16,438 EDOU patients with similar distributions for age and gender, and differences in health insurance and diagnosis. For both discharged and admitted patients, the mean cost was higher in the NOU setting at $7989 than the virtual-EDOU setting at $4876 with an adjusted difference of $1951 (95% CI: $1762-$2133). The mean total length of stay was higher in the NOU setting (60.5 h) than the virtual-EDOU setting (36.4 h) with an adjusted difference of 20.4 h (95% CI: 19.2 h - 21.3 h). NOU inpatient admission rates were higher (25.3% vs 18.4%). Cost and length of stays were lower in discharged observation patients, with differences favoring the virtual-EDOU group. Adverse events were higher in the NOU setting (2.1% vs 0.8%). 30-day ED recidivism did not differ significantly between NOU and virtual-EDOU study groups. The virtual-EDOU saved the two hospitals $16,036,913 and 6986 bed-days annually.
Management of observation patients in a virtual-EDOU setting is superior to care in a traditional inpatient setting in terms of costs, length of stays, inpatient admission and adverse events rates.
虚拟急诊观察单元（EDOU）护理相对于传统住院观察护理的益处尚不清楚。
确定虚拟 EDOU 观察护理与传统非观察单元（NOU）住院病床观察护理相比，是否与缩短住院时间、降低成本、降低住院率和减少不良事件相关。
这是一项在两家城市教学医院进行的为期 24 个月的观察患者回顾性观察队列研究。在急诊科就诊后，根据床位可用性、医生酌处权和观察指南，在虚拟-EDOU 或 NOU 住院环境中进行观察护理。主要结局为住院时间、总费用、住院率和不良事件（死亡或 ICU 入院）。使用医院成本和临床数据库。使用双重稳健回归与熵平衡和倾向评分进行分析，以控制亚组差异。
30191 名观察患者分为 13753 名 NOU 患者和 16438 名 EDOU 患者，年龄和性别分布相似，医疗保险和诊断存在差异。对于出院和住院患者，NOU 环境的平均费用为 7989 美元，高于虚拟-EDOU 环境的 4876 美元，调整后的差异为 1951 美元（95%CI：1762-2133）。NOU 环境的平均总住院时间（60.5 小时）长于虚拟-EDOU 环境（36.4 小时），调整后的差异为 20.4 小时（95%CI：19.2-21.3 小时）。NOU 住院率较高（25.3%比 18.4%）。观察患者出院时的费用和住院时间较低，虚拟-EDOU 组有优势。NOU 环境的不良事件发生率较高（2.1%比 0.8%）。30 天 ED 再入院率在 NOU 和虚拟-EDOU 研究组之间无显著差异。虚拟-EDOU 每年为这两家医院节省 16036913 美元和 6986 个床位日。
与传统住院环境相比，虚拟 EDOU 环境中观察患者的管理在成本、住院时间、住院率和不良事件发生率方面更具优势。
