[Emergency admissions to a department of internal medicine. Are departments of internal medicine used optimally, and how would observation units affect the management of the department?].

279 consecutive emergency admissions to our Department of Internal Medicine were reviewed. Admission was appropriate for 58%. These patients consumed 88% of the "ward-days" during the period studied. Of the remaining patients, 22% could have been treated adequately in an observation unit, 10% need not have been hospitalized, and 10% should have been admitted to a different department. All stays in hospital lasting more than 50 days were due to lack of a place in a nursing home. If no patient had to wait more than 50 days, this would release 23% of the total "ward-day" capacity. The pressure on Departments of Internal Medicine could be reduced substantially by establishing observation units, and reducing the waiting time for a place in a nursing home.