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In Reply Ross and Hockenberry describe how protocols have been used to improve the efficiency of observation units in emergency departments. Data from observation units in emergency departments,1 however, cannot be used to compare costs and lengths of stay for the entire spectrum of observation care at a hospital. From emergency department observation units, there are randomized trials for patients with chest pain, asthma, transient ischemic attack, atrial fibrillation, and syncope.1 At our hospital, however, patients with these 5 diagnoses account for only about 20% of patients with observation status. In our study, patients hospitalized for observation had 1141 different diagnosis codes.2
Sheehy AM. Dedicated Observation Unit for Patients With “Observation Status”—Reply. JAMA Intern Med. 2014;174(2):301-302. doi:10.1001/jamainternmed.2013.13477