Emergency Medicine Residency Training in Observation Medicine: The Time is Now

The protocol-driven dedicated observation unit, which is the model for emergency medicine (EM) observation, has resulted in lower costs, shorter lengths of stay, lower rates of inpatient admissions, better clinical outcomes, and improvements in resource utiization.¹ Concurrently, from 2003 to 2011, the percentage of hospitals that reported having an OU increased from 19% to 36%, with most of them being EM managed and run.^2,3

The 2016 Model of the Clinical Practice of Emergency Medicine included observation unit medicine as part of the practice of EM.⁴  Due to this expansion of observation unit management in EM, there are now a multitude of training and fellowship programs run by EM departments in observation unit medicine. EM residency graduates are increasingly being recruited with expectations that they will be comfortable working in an observation unit. 

In 2002, Mace, et al, showed observation unit education in EM residencies was sparse. This survey showed that 36% of allopathic EM programs had observation units, 37% of programs had resident lectures on the topic, 10% of programs required resident rotations in the observation unit, and 25% offered the rotation as an elective.⁵ Antidotal evidence makes it seem that these numbers have not changed in the last 15 years.

Since EM has taken the lead in running and implementing observation units around the country, the time has come to fully incorporate training in observation medicine into the EM residency training curriculum. There are curriculum models already available. The emergency department-run observation unit is here to stay, and we have a responsibility to train our graduates to be comfortable and capable to deliver high quality care in that environment.

References

1. Ross MA, Aurora T, Graff L, et al. State of the art: emergency department observation units. Crit Pathw Cardiol. 2012;11(3):128–38.
2. Mace SE, Graff L, Mikhail M, et al. A national survey of observation units in the United States. Am J Emerg Med. 2003 Nov;21(7):529–33.
3. Wiler JL, Ross MA, Ginde AA. National study of emergency department observation services. Acad Emerg Med. 2011 Sep;18(9):959–65.
4. Counselman FL, Babu K, Edens MA, et al. The 2016 model of the clinical practice of emergency medicine. J Emerg Med. 2017 Jun;52(6):846-9.
5. Mace S, Shah J. Observation medicine in emergency medicine residency programs. Acad Emerg Med. 2002 Feb;9(2):169–71.

Steven Sattler, DO, FACEP
Co-Director, Observation Medicine
Good Samaritan Hospital Medical Center
Progressive Emergency Physicians