Table 1 Comparison between key operational characteristics of emergency department (ED) observation units (OUs) in the United States and Asia

General data*

- Hospital beds

809 beds (650–1,026 beds)

1,269 beds (907–1,500 beds)

- ED beds

62 beds (44–86 beds)

Mostly do not have fixed bed

- ED patients/day

421 patients (150–332 patients)

665 patients (120–320 patients)

- OU patients/day

21 patients (17–28 patients)

14 patients (2–24 patients)

- OU beds

17 beds (8–32 beds, some can expand status OU in ED area)

13 beds (8–16 beds)

- Location

Contagious

Contagious and nearby

- How many years since OU started in average (years)

14 years (9–17 years)

3 years (1–6 years)

OU length of stay (LOS), bed turnover rate, and reasons for longer stay

LOS

- Definition of times for OU LOS

From the time of the physician order to start observation status (although the patient still in ED) until bed request or discharge status

No clear definition

- Maximum allowed OU LOS

24 hours

24 hours

- Acute care ED LOS prior to OU admission

3–5 hours

2 hours

- OU LOS in average

12.9 hours (13–15 hours)

20.5 hours (15–26 hours, 1 did not answer)

- OU discharge rate

84.3% (83–85%)

88.7% (87–92%)

Bed turnover rate (patients/bed/day) on average

1.6 (0.8–2.1)

0.9 (0.3–1.5)

Reasons why patients stay longer than maximum LOS

Prolonged test results, imaging, consults, limited inpatient psychiatric beds, social work

Completion of patient therapy or clinical improvement, limited inpatient general beds, social work

Characteristic operation in different axes

Policy and protocol

- Protocol used in OU

Yes

1 site does not have

- Policy manual available

Yes

1 site does not have

- Policy manual updated annually

1 site does not have

1 site does not have

- Number of OU protocols in use

2, 11, 18

0, 30, 38

- Most common OU protocols

Chest pain, Generic, Abdominal pain

Chest pain, Abdominal pain, Head injury

OU staffing model

- OU staffing model

MD, PA, NP, RN, MA

MD, RN, MA

- Doctor (MD) availability

Available all the time but physically is 2–4 hours in average

Available all the time but physically is 2–4 hours in average

- Nurse practitioners (NP) and physician assistants (PA)

2 sites have PA, 1 site does not have

Do not have the NP and PA

- Nurses (RN)

Available all the time and 1 RN staffs 5–8 beds

Available all the time and 1 RN staffs 5–8 beds

- Medical assistants (MA)

Yes

1 site has

- The personnel department works in OU, how often?

Work in OU and ED

Work in OU and ED

Psychosocial issues

- Psychiatric area in ED

1 site has

1 site has

- Psychiatric and suicidal patient accepted in OU area

1 site accepts

1 site accepts

1 site does not accept

1 site does not accept but can be placed in observation status

- Social worker availability

Daily

Weekdays

- Case manager availability

Daily

2 sites do not have

1 site has on weekdays

Investigation and continuation of care axis

- Physical therapy availability

Daily

Weekdays

- Attending emergency radiologist

Daily

2 sites do not have Emergency Radiologist

1 site has 24/7

- MRI and interpretation

Daily

Only Emergency

- Stress test availability and turn-around time

Yes, 1–3 hours

2 sites do not have

1 site has, 2 hours

Patient satisfaction

- OU patient satisfaction measured

Yes

2 sites do not measure

- Instruments used to measure

Press Ganey, Internal questionnaire, phone calls

Questionnaire survey

- Results of OU patient satisfaction survey

1 site 90%

1 site positive but not quantified

1 site 83%

2 sites no answer

1 site no answer

Financial axis

- Opportunity for additional payment for patients admitted to OU

Yes

No

- Financial incentive for attending physician staff to use OU

Yes

No

- Additional direct payment to attending physician for assigning each patient to OU

1 site has

No

Interrogate and suggestion

- What happens to OU candidates in your ED if the OU is full

Wait in the ED area

Wait in ED or Direct admission to general ward

- Are OU beds used for other proposes

2 sites use; fast track, inpatient border, procedures

No

1 site does not use