The effect of an observation unit on the rate of ED admission and discharge for pyelonephritis

• Published in: The American journal of emergency medicine Vol. 28; no. 6; pp. 682 - 688
• Main Authors: Schrock, Jon W., Reznikova, Svetlana, Weller, Suki
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2010; Elsevier; Elsevier Limited
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anti-Bacterial Agents - therapeutic use; Antibiotics; Biological and medical sciences; Blood; Clinical Protocols; Cohort Studies; Cost control; Disease; Emergency; Emergency medical care; Emergency Service, Hospital - organization & administration; Female; Hospital costs; Hospital Units - organization & administration; Hospitalization - statistics & numerical data; Humans; Infections; Intensive care medicine; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Medical treatment; Middle Aged; Outcome and Process Assessment (Health Care); Pain; Pyelonephritis - diagnosis; Pyelonephritis - etiology; Pyelonephritis - therapy; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Recidivism; Respiratory system; Retrospective Studies; Risk factors; Spinal cord; Young Adult; Kidney disease; Admission discharge; Intensive care; Urinary system disease; Pyelonephritis; Resuscitation; Ascending pyelonephritis
• ISSN: 0735-6757; 1532-8171; 1532-8171
• DOI: 10.1016/j.ajem.2009.03.003

We sought to determine if the opening of an adult emergency department (ED) observation unit (OU) would impact the rate of hospital admission and ED discharges for pyelonephritis. A retrospective cohort study was performed with all adult patients from October 2003 through December 2006 in the ED meeting inclusion criteria for pyelonephritis. Clinical, demographic, and laboratory data were recorded. Primary outcomes were rates of admission, ED discharge, and return ED visits before and after the opening of our OU. We compared admission, discharge, and readmission rates using the χ 2 test. Nine hundred thirty charts were reviewed with 633 included for analysis. Urine cultures were performed on 420 subjects with 71% being positive. The percentage of patients admitted to a hospital inpatient unit from the ED decreased from 36% to 26% (relative risk [RR], 0.73; P = .01) after opening the OU. The percentage of patients discharged home from the ED decreased from 65% to 51% (RR, 0.76; P < .001). Among OU patients, 29% were admitted to the hospital for further inpatient care. Emergency department recidivism was unchanged by opening the OU (RR, 0.86; P = .68). The creation of an OU appears to influence admission decisions of ED physicians. We found that the creation of an OU significantly reduced hospital admissions for pyelonephritis but also significantly reduced ED discharges to home for pyelonephritis at our institution.