title: Effect on efficiency and cost-effectiveness when an observation unit is managed as a closed unit vs an open unit.
abstract: OBJECTIVE
  To compare efficiency and cost-effectiveness of an observation unit (OU) when managed as a closed unit vs an open unit.
  
  
  METHODS
  This observational, retrospective study of a 30-bed OU compared three time periods: Nov 2007 to Aug 2008 (period 1), Nov 2008 to Aug 2009 (period 2) and Nov 2010 to Aug 2011 (period 3). The OU was managed and staffed by non-emergency department physicians as an open unit during period 1, and a closed unit by emergency department physicians during periods 2 and 3.
  
  
  RESULTS
  OU volume was greatest in period 3 (1 vs 3, 95% CI -235.8 to -127.9; 2 vs 3, 95% CI -191.9 to -84.095%). Periods 2 and 3 had shorter lengths of stay for discharged (1 vs 2, 95% CI -6.6 to 1.7; 1 vs 3, 95% CI -8.1 to -3.1) and admitted (1 vs 2, 95% CI -11.4 to -8.6; 1 vs 3, 95% CI -11.8 to -9.0) patients, less admission rates (P < .001), and less 30-day all cause admission rates after discharge (P < .0001). Cost was less during periods 2 and 3 for direct (1 vs 2, 95% CI -392.5 to -305.9; 1 vs 3, 95% CI -471.4 to -388.4), indirect (1 vs 2, 95% CI -249.5 to - 199.8; 1 vs 3, 95% CI -187 to-139.4) and total cost (1 vs 2, 95% CI -640.7 to -507; 1 vs 3, 95% CI -657.2 to -529).
  
  
  CONCLUSIONS
  The same OU was more efficient and cost-effective when managed as a closed unit vs an open unit.
authors.affiliation: St. John Hospital and Medical Center, Dept. of Emergency Medicine, Detroit, MI 48236, USA.
authors.forename: Margarita E
authors.initials: ME
authors.lastname: Pena
authors.forename: James M
authors.initials: JM
authors.lastname: Fox
authors.forename: Anthony C
authors.initials: AC
authors.lastname: Southall
authors.forename: Robert B
authors.initials: RB
authors.lastname: Dunne
authors.forename: Susan
authors.initials: S
authors.lastname: Szpunar
authors.forename: Stephen
authors.initials: S
authors.lastname: Kler
authors.forename: Robert B
authors.initials: RB
authors.lastname: Takla
mesh_terms: D003362:Cost-Benefit Analysis; D017598:Efficiency, Organizational / Q000191:economics / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006757:Hospital Units / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008824:Michigan; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies