Observation Medicine Belongs to Emergency Medicine

I started my first observation unit over 15 years ago, and even now, as then, it is not exactly settled opinion that observation should be a part of emergency medicine. But it should be. That is one of this company’s central insights about observation medicine, and a big part of what interested me in joining as its Observation Services Medical Director.

The ER works on a very short time duration in caring for patients, usually three to four hours. In observation, we work on an 18-24 hour time frame. But the world of hospital medicine usually works on a four-day length of stay. For that and other reasons, observation should really fall under that umbrella of emergency services.

I did ER medicine from 1988 until 2003. Then, in 1996, I started a small six-bed observation unit, the first one in New York State. In 2003, I left the ED to start a 24-bed observation unit at the University of Rochester, which grew into a 36-bed unit until I left at the end of 2008. In 2009, I went to Rochester General Hospital and started a 22-bed observation unit, which I ran until 2011. Now at MEP, I am putting an operational model in place for the observation unit at Shady Grove Adventist Hospital.

An observation stay costs Medicare far less than an inpatient stay in the hospital. It’s really a cost savings, besides showing better outcomes for patients. As the healthcare system continues to find new and different ways to incentivize less costly, more effective care, hospitals will only have a growing interest in observation services.

Without observation medicine, i.e., without a defined place and structure for the sorts of patients that observation medicine treats, the hospital is left with these kinds of patients scattered all over. This often means the patients stay in the hospital longer. And the longer a patient is in the hospital, the more it costs to care for them. And so the hospital is using its hospital beds—very expensive beds—to take care of these low-level patients.

And that’s the whole idea behind observation units—to take a group of low-level patients, use criteria to determine the patient’s severity of illness and provide efficient evaluation, management and care. If the patient doesn’t have a serious illness, the goal is to discharge the patient within 24 hours. It helps the patient get out there doing whatever they do quicker and it saves the hospital dollars and cents.

It is often said we are in the world of McDonald’s healthcare, meaning they want it fast – in and out. People don’t really want to come to the hospital. And if they do come to the hospital, they want to come and find out what’s wrong with them and they want to find it out as quickly as possible so they can get back to doing what they want to do. It’s not exactly a vacation destination.

What I’m looking forward to is the growth of observation medicine. I’m also looking forward to developing an educational clinical model for our Advanced Practice Professionals. Right now maybe 20 percent of hospitals have an observation unit. Meanwhile, we have observation units at two of its six hospital campuses. So we are ahead of the curve in this area (and we aim to stay that way, I might add), having embraced it as a key component of care delivery.