# The 17‑Hour Turnaround: Rapid, Safe Observation Care For Older Adults About This Podcast In this GEMCast episode host Dr. Christina Shenvi is joined by Dr. Meredith Busman, Director of Observation Medicine at Corewell Health West in Grand Rapids Michigan, Program Director for the Observation Medicine Fellowship at Emergency Care Specialists, and co-chair of the ACEP Accelerate Observation Medicine: Science and Solutions conference. Observation medicine is an outpatient service that encompasses rapid treatment, assessment, and reassessment of select patients with the hopes of avoiding admission. Learn more about this new and rapidly developing subspecialty of emergency medicine, how ED-directed observation units function, and how they are particularly beneficial for older patients or those with dementia. The care provided in an observation unit uses predetermined protocols and pathways, leading to the notably shorter length of stay (LOS) – Dr. Busmans’ unit has an average LOS of just 17 hours! A rapid turnaround, coupled with efficient care from specialists and multidisciplinary input, leads to better outcomes for patients. In older patients who are susceptible to unfavorable outcomes such as delirium and deconditioning from either ED boarding or inpatient stays, the impact of a specialized service can be significant on acute and long-term health. Alongside the benefits for patients, an observation unit helps offload patients from other services and can improve patient flow through busy EDs. Play the Episode https://youtu.be/8T7hRT-OXls Subscribe on YouTube Subscribe on iTunes Key points Cohorted and protocolised care is essential to observation medicine. Having good protocols and pathways in placement from day one, and making sure that consultants and specialists are on board, means your workflow will be efficient. For example, a patient with CHF will get a standard care bundle including a cardiology consult, an updated echocardiogram, and diuresis prior to reassessment. Minimising the LOS helps reduce potential harms from hospital stays. It can take months for bone density to recover after 10 days of bed rest. Muscle strength can decline 10% per week in young healthy men, with more significant impacts on frail patients. As such, the default should be to get out of bed early and often (with the help of PT if needed). Many services can be embedded within an observation unit: case management, physiotherapy, occupational therapy, pharmacy, etc. The multidisciplinary input promotes recovery from acute illness and prevention of new illnesses. When assessing and treating an older patient in an observation unit use your geriatrics team!They are experts on medication management (eg, pain management, potential interactions, BEERS criteria for potentially inappropriate medications). They can help educate other providers on delirium screening and prevention. A few practical tips for if a patient develops delirium:Reorient the patient (eg, familiar people at bedside), reduce sleep interruptions, and cluster labs, medications & assessments where possible. If agitated, never use physical restraints and avoid medications where possible. If medications are required, opt for antipsychotics (risperidone or olanzapine), avoiding benzodiazepines or anticholinergics. Discharge may involve referral for home PT/OT or health services, specialty follow-ups (eg, orthopaedics for trauma, neuropsychology if cognition concerns), or even making appointments with a patient’s PCP before they leave the unit. Dr. Busman highlights that using a same-day ED-run clinic as a bridge for rechecks to avoid ED revisits while awaiting PCP appointments. Essential to explain to your hospital C-suite that an observation unit will not be full 24/7 and empty beds cannot be filled with inpatient boarders, but that it can increase patient turnover and offload other services (eg. medicine, specialties, ED). Next, listen to Delirium Clinical Practice Guidelines: What Do We Know, and What Should We Do? with Dr. Danya Khoujah Play Episode TOOLKIT | December 18, 2025 Addressing Boarding in the Geriatric ED This toolkit provides tools, recommendations, guidelines, and educational resources for EDs to implement processes that address the problem of boarding. It contains essential background and real-world examples of successful boarding protocols and a slide deck presenting the financial and patient-centred benefits of boarding reduction practices. Explore Toolkit View All Boarding Resources >