Short stay unit/observation unit: a new paradigm

A short unit is a new concept of emergency medicine where patients are under the care of a proper staff connected daily to the emergency department staff. This remains true even considering that patients are also admitted to the unit from other care sites or at the request of other services.

It is a protocol-driven unit designed for patients who require short-term interventions or additional time for treatment or diagnosis; it is not intended for patients with significant illnesses that require full hospital level services, including significant interventions. Patients who are not able to complete their course of treatment and leave the unit to home at about 48 h are supposed to be transferred to regular units.

The short stay unit has been designed as a unit for care of patients who need a short time for additional treatment on diagnosis. From September 1999 to March 2001, 945 consecutive patients were admitted to Pró-Cardíaco short stay unit. Approximately 66% of these came from the emergency department, and about 80% could be discharged home from the unit. Mean age of the patients was 65 years, with a mean time of hospital stay of 1.83 days. Fifty per cent of admissions had a cardiovascular origin with a mean time of stay of 1.88 days, and 50% were of noncardiovascular origin (mean time of stay 1.78 days).

Excluding admissions secondary to intrahospital interventions (which were about 25%), the most frequent diagnosis were as follows: chest pain 16%, 1.4 days; infectious syndromes 9.3%, 2.0 days; atrial fibrillation/flutter 8.6%, 1.66 days; syncope 5.5%, 1.38 days; heart failure 4.3%, 2.5 days; and TIA/ischemic stroke 3.9%, 1.7-2.5 days.

Conclusion

The short stay unit represents an extension of the concept of chest pain units for prevalent situations seen at the emergency department.