[Assessment of the appropriate utilization of an emergency department observation unit with the Appropriateness Evaluation Protocol: analysis of 4,700 cases].

BACKGROUND: The Emergency Department Observation Units (EDO) constitutes an alternative of conventional hospitalization. The admissions and stays' appropriateness may influence the efficient use of bed resource in an acute care hospital. METHOD: Prospective evaluation of EDO admissions in a 18 month period, using the original criteria of Appropriateness Evaluation Protocol (A.E.P.), which were adapted to the area characteristics. RESULTS: We evaluate 4,700 admissions (55.1% male, 44.9% female; mean age: 64.9 +/- 14.9 years old). Average length of stay was 23.8 (+/- 18.3) hours. 35.5% patients were discharged at home and 62.0% were admitted in hospital. In 98.1% patients we obtained clinical stabilization in 48 hours. 85.0% of admissions were explained by 35 DRG categories, the most prevalent being chronic obstructive pulmonary disease (COPD) (411 admissions, 9.0%). A total of 258 (5.5%) admissions were qualified as inappropriate, primary due to diagnostic and therapeutical services that could have been provided in an outpatient basis (3.4%). A total of 797 (17.0%) stays were considered inappropriate, mainly due to hospital bed occupancy (13.0%) and discharge delays because of conservative medical management of patients (3.4%), social problems representing only 0.6%. A daily average of 4.2 beds (total of 19) were inappropriate used as assessed by modified AEP criteria. DISCUSSION: EDO represents an alternative for conventional hospitalization, obtaining patient clinical stabilization in 48 hours and saving unnecessary hospital admissions. AEP application lets know the impact of the efficient use of this area in the emergency department and the hospital.