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Invited Commentary
November 25, 2013

Observation Status for Hospitalized Patients: A Maddening Policy Begging for Revision

Author Affiliations
  • 1Department of Medicine, University of California, San Francisco
JAMA Intern Med. 2013;173(21):1999-2000. doi:10.1001/jamainternmed.2013.7306

“But I don’t want to go among mad people,” Alice remarked.
“Oh, you can’t help that,” said the Cat: “we’re all mad here. I’m mad. You’re mad.”
“How do you know I’m mad?” said Alice.
“You must be,” said the Cat, “or you wouldn’t have come here.”

Lewis Carroll, Alice in Wonderland

When I was a resident at San Francisco General Hospital, the very busy Emergency Department had an “observation unit”—an adjacent room in which patients could receive additional diagnostic tests or therapies before it was determined whether they needed to be admitted. It was a useful idea. Many patients with asthma, chest pain, drug overdoses, alcohol intoxication and withdrawal, and dehydration went “to obs” for a dozen hours or so of observation before receiving their ultimate disposition: home or hospital.