Hello friends! Seeking some input and/or information regarding your ED observation units, if you've got them.
I'm going to be starting as the geriatric emergency medicine fellow next year at my institution. There exist only 5 of these across the country and without ACGME accreditation or certification, there is plenty of variability in the curricula. I myself am the first fellow at our hospital, and have been given a fair bit of freedom to construct my own curriculum. It encompasses administrative aspects, palliative care, geriatric medicine (just more troponins and CTs, right?), and successful operation and construction of an ED observation unit. Shockingly, our level 1 trauma and academic medical center does not currently house an observation unit, so that will be a unique opportunity for me to learn and build one from the ground level.
My question is this: for those of you out there who work in an ED with an obs unit, what typically is being sent to the obs unit that doesn't necessarily need to go to the floor under the care of the hospitalist. There has been much discussion about what should and shouldn't go to an ED obs unit. Arguably (as Slovis said in one of his ACEP talks this year), the ED is faster, better, and more efficient at doing many things, including workups that previously may not have been done in the ED. Syncope is a good example of this. Syncope work up (Echo, ultrasound, 23 hr tele monitor) can be done faster and cheaper in the ED these days. Other things that seem suitable for an ED-obs unit are cellulitis (marking pen and IV abx for 23 hours), low risk chest pain risk stratification, short stay overnight for specialist studies such as GI scope the next day, a temporary place for an older patient who shouldn't go back to their SNF at 3am but doesn't need to take up a hospital bed. These are just a few examples...
What are you guys putting in your obs units and what specifically are you NOT putting in there anymore because it became a problem within your specific system.
Feel free to post or just private message me on the matter. Thanks for the time and consideration!
I'm going to be starting as the geriatric emergency medicine fellow next year at my institution. There exist only 5 of these across the country and without ACGME accreditation or certification, there is plenty of variability in the curricula. I myself am the first fellow at our hospital, and have been given a fair bit of freedom to construct my own curriculum. It encompasses administrative aspects, palliative care, geriatric medicine (just more troponins and CTs, right?), and successful operation and construction of an ED observation unit. Shockingly, our level 1 trauma and academic medical center does not currently house an observation unit, so that will be a unique opportunity for me to learn and build one from the ground level.
My question is this: for those of you out there who work in an ED with an obs unit, what typically is being sent to the obs unit that doesn't necessarily need to go to the floor under the care of the hospitalist. There has been much discussion about what should and shouldn't go to an ED obs unit. Arguably (as Slovis said in one of his ACEP talks this year), the ED is faster, better, and more efficient at doing many things, including workups that previously may not have been done in the ED. Syncope is a good example of this. Syncope work up (Echo, ultrasound, 23 hr tele monitor) can be done faster and cheaper in the ED these days. Other things that seem suitable for an ED-obs unit are cellulitis (marking pen and IV abx for 23 hours), low risk chest pain risk stratification, short stay overnight for specialist studies such as GI scope the next day, a temporary place for an older patient who shouldn't go back to their SNF at 3am but doesn't need to take up a hospital bed. These are just a few examples...
What are you guys putting in your obs units and what specifically are you NOT putting in there anymore because it became a problem within your specific system.
Feel free to post or just private message me on the matter. Thanks for the time and consideration!