title: The effect of an observation unit on the rate of ED admission and discharge for pyelonephritis.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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 chi(2) test.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Emergency Medicine, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44109-1998, USA. jschrock@metrohealth.org
authors.forename: Jon W
authors.initials: JW
authors.lastname: Schrock
authors.forename: Svetlana
authors.initials: S
authors.lastname: Reznikova
authors.forename: Suki
authors.initials: S
authors.lastname: Weller
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002985:Clinical Protocols; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006757:Hospital Units / Q000458:organization & administration*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011704:Pyelonephritis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents