The Office of Observation Medicine has been a work in progress for the Department of Emergency Medicine since 2007 when Dr. Jeremy Thomas joined the faculty. , Finally, in July of 2015 with the opening of the UAB Outpatient Clinical Decision Unit (OCDU), the Office of Observation Medicine became official. The OCDU is a 20 bed dedicated unit for protocol driven care of a specific subset of patients in observation status within UAB Hospital. The unit has multiple set diagnoses that can be admitted for OCDU care. There are set inclusion and exclusion criteria that must be met for each diagnosis prior to placement on the care protocol within this unit. The OCDU patients are cared for by the UAB Hospitalist Service and their APP team once they leave the ED, with Co-Medical Direction from Dr. Jeremy Thomas of the ED and Dr. David McCollum of the Hospitalist Service. The unit is viewed as an extension of the ED, with the desired impact to improve patient throughput for both the ED and the entire hospital, reduce the frequency of denials of payment by all payers to the hospital, decreased 30 day re-admission rates across the hospital, and the creation of new “available bed days” within hospital through decreased length of stays and offloading other inpatient services.

The OCDU works closely with the ED to move patients from the ED to the unit quickly, in order to make ED space available for the next patient. The unit has seen significant increase in utilization over the first 6 months, and there has been continued expansion of the diagnoses that have approved protocols for care. Patient populations that can be cared for in the OCDU currently include Chest pain (intermediate risk), Deep Venous Thrombosis, COPD, Pneumonia (uncomplicated), Cellulitis, Closed Head Injury, Syncope, and UTI/Pyelonephritis.

The future of the Office of Observation Medicine includes multiple areas of expansion and growth. The OCDU will continue to grow and expand the number of protocols (considerations include overdose, venomous snake bites, mild DKA) for care as long as we are meeting a valuable need for the hospital and the Health System. Other opportunities of future expansion include an ED Observation care area adjacent to the UED in the future for the subset of observation patients that the ED providers are more comfortable with or may be able to disposition the most quickly (accidental overdose, hypoglycemia, closed head injury, …). There is also ongoing evaluation of a possible Geriatric Observation are adjacent to the HED, which will be a collaboration between the Department of Emergency Medicine and the Division of Geriatrics.

Observation care is a growing necessity in the changing world of hospital based medicine. As health care reform continues to progress, the ability to provide quality, evidence based, efficient and affordable care to our patients is essential. The ability to do all of these things while minimizing the duration of care, minimizing the hospital cost and resources utilization, all the while, maintaining the patient in an outpatient status will be a critical skill in the setting of hospital based medicine now and in the future.