The Value of an Emergency Medicine Virtual Observation Unit - 26/03/24

Doi : 10.1016/j.annemergmed.2024.02.001

Emily M. Hayden, MD, MHPE ^⁎ , Beth G. Grabowski, MBA, MPH, Ekta B. Kishen, MPH, Kori S. Zachrison, MD, MSc, Benjamin A. White, MD
Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA

^∗Corresponding Author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Tuesday 26 March 2024

Abstract

Study objective

We implemented a virtual observation unit in which emergency department (ED) patients receive observation-level care at home. Our primary aim was to compare this new care model to in-person observation care in terms of brick-and-mortar ED length of stay (inclusive of ED observation unit time) as well as secondarily on inpatient admission and 72-hour return visits (overall and with admission).

Methods

In a retrospective analysis of electronic health record data on ED observation patients from January 1, 2022 to December 29, 2022 from an academic urban ED, we used propensity matching to compare virtual to in-person observation patients on outcomes of interest. Patients were matched 1:1 based on age, sex, Charlson Comorbidity Index, and reason for observation. We also conducted real-time review of all virtual observation cases for potential safety concerns.

Results

Of 8,218 observation stays, 361 virtual observation patients were matched with 361 in-person observation patients. Virtual observation patients experienced lower median brick-and-mortar ED + EDOU LOS [14.6 (IQR 10.2, 18.9) versus 33.3 (IQR 28.1, 38.1) hours] and lower inpatient admission rates (10.2% [SD 5.0] versus 24.7% [SD 11.3]). The 72-hour return rate was higher for virtual observation patients (3.6% [SD 3.0] versus 2.5% [SD 3.0]). Among those with return visits, the rate of inpatient admission was higher among virtual observation patients (53.8% [SD 3.2] versus 11.1% [13.0]). There were no significant patient safety events recorded.

Conclusion

Virtual observation unit patients used fewer hours in ED and ED observation relative to on-site observation patients. This new care delivery model warrants further study because it has the potential to positively impact ED capacity.

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Plan

Introduction

Materials and Methods

Study Design and Setting

Selection of Participants

	Supervising editor: Stephen Schenkel, MD, MPP. Specific detailed information about possible conflict of interest for individual editors is available at editors.
	Author contributions: EMH, BGG, EBK, KSZ, and BAW helped with study concept and design. EBK acquired, analyzed, and interpreted the data. EMH drafted the manuscript. EMH, BGG, EBK, KSZ, and BAW critically revised the manuscript for important intellectual content. EBK, BGG, and KSZ provided statistical expertise. EMH takes responsibility for the paper as a whole.
	Data sharing statement: The deidentified dataset, data dictionary, and analytic code for this investigation are available upon request, while complying with the institution’s data sharing policy and requirement for a data use agreement, from the date of article publication by contacting Emily M. Hayden, MD, MHPE at emhayden@mgh.harvard.edu.
	All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
	Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist.
	Presentation information: This work was presented as an abstract at the Society for Academic Emergency Medicine Annual Meeting 2023 on May 17, 2023 in Austin, TX.
	Please see page XX for the Editor’s Capsule Summary of this article.