Background
Emergency medicine providers decide the disposition of the older patient during the formulation of their care plan. The improvements in practice and screening tools of Geriatric Emergency Department may identify those older adults who need further evaluation and care while addressing their medical condition.1,2 For Medicare beneficiaries who have unscheduled or acute conditions in whom the trajectory of illness is uncertain or the response to treatment is awaited, an observation stay is often chosen. These patients have an expected length of stay that will not exceed two midnights in the hospital.3,4 The observation stay is usually measured in hours, as opposed to hospital care which is measured in days. The purpose of observation is for the health care provider to determine whether the patient presenting with an unscheduled acute condition requires hospitalization or can be safely discharged. While some emergency departments have an observation area,5 most patients are sent to a medical surgical nursing unit. This is similar to the course of care for those patients who are admitted.
At times observation care vs inpatient care may be indistinguishable for the patient and the staff providing the care. In fact, some patients shift from observation status to inpatient status and vice versa during their stay in the hospital. This is in the context of the Hospital Readmissions Reduction Program and hospitals’ efforts to properly determine if the individual patients care as an admission, a readmission or an observation stay.6,7 Details of the administrative determination of hospital admission are described elsewhere.8 Likewise, we will not discuss the costs of the care for the Medicare beneficiary.8 While the designation of their Medicare stay and the Medicare payment is an important concern, the patients’ need for excellent care continues. We describe key geriatric principles and systems- based practices to observation stay for older adults.