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Comment & Response
February 2014

Dedicated Observation Unit for Patients With “Observation Status”

Author Affiliations
  • 1Department of Emergency Medicine, Emory University, Atlanta, Georgia
  • 2Department of Health Policy and Management, Emory University, Atlanta, Georgia
  • 3Department of Veterans Affairs (VA) Center for Comprehensive Access Delivery Research and Evaluation, Atlanta, Georgia
JAMA Intern Med. 2014;174(2):301. doi:10.1001/jamainternmed.2013.13485

To the Editor Sheehy and colleagues1 detail the financial losses associated with patients admitted to “observation status” at an academic medical center.

It is noteworthy that the study hospital does not have a dedicated observation unit, despite an average of more than 8 patients a day receiving observation care, a volume of patients that could easily support such a unit. Eight prospective randomized trials have shown lower costs and length of stay for patients in observation units compared with those admitted as inpatients for conditions such as chest pain, asthma, transient ischemic attack, and atrial fibrillation.2,3 There have also been several single center studies of the many conditions managed in observation units, showing that lengths of stay are comparable to those reported in randomized trials.2,3

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