Focus on Observation
Is 'observation' an obsolete term?
`Clinical decision unit' may better describe service
Some say the term "observation" no longer accurately reflects the range of services provided in so-called observation units. "The profession is groping to find the right language to describe the unit's function," says Tony Joseph, MD, MS, former chairman of the section on short-term observation services of the American College of Emergency Physicians (ACEP) in Dallas and the founder of American Medical Consulting in Columbus, OH.
Observation units originated as holding units for patients waiting for an inpatient bed, but their role has expanded considerably. The units are utilized today when it's not clear whether a patient needs hospitalization. The period of observation clarifies whether hospitalization is warranted. "The current incarnation is not the static observation of the holding unit, but a dynamic unit where ongoing evaluation, analysis, treatment, and decision-making takes place," says Robert Andelman, MD, FACEP, regional director of emergency services for Ohio Permanente Medical Group in Akron, and another former chairman of ACEP's section on observation services.
To replace "observation unit," experts suggest such terms as "short-stay diagnostic unit" or "clinical decision unit." "The word `observe' is really a misnomer because it has a very passive meaning - like you're watching something," says Joseph. These units are now places where patients are receiving very aggressive diagnoses and treatment regimens. Today's units typically are used for patients with any number of diagnoses, including allergic reaction cellulitis, atrial fibrillation, drug overdose, GI bleeds, headaches, and trauma, as well as treatments such as inhalation therapy and postoperative surgeries.
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