Observation Medicine: Principles and Protocols

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Observation medicine is outpatient care that includes short-term treatment and assessment provided in a hospital bed, usually for a period of <24 hours (sometimes <48 hours) to determine the need for admission. With the ever-increasing number of emergency department visits over the past few decades, leading to overcrowding, overutilization, escalating health care costs, and avoidable admissions, observation medicine has become one of the fastest-growing subspecialties in emergency medicine. Observation Medicine: Principles and Protocols, edited by Sharon E. Mace, comes at a time when most hospitals are facing enormous pressures to provide value-based care in an era of cost containment.
A leader in observation medicine, Mace has more than 28 years of experience in clinical, administrative, and academic emergency medicine practice. She has authored more than 100 articles and 30 textbook chapters, as well as lectured both nationally and internationally on observation medicine.
Observation Medicine is divided into 10 parts and 96 well-defined chapters. The first 3 parts focus on developing and maintaining an observation unit in diverse settings, from a rural community hospital to a tertiary care hospital in an academic center. They explain how to improve the overall quality of an observation unit, taking into consideration the processes that improve the efficiency and effectiveness of health care workers, and therefore improving their quality of service. Part I describes the different types of observation units, the evolution of observation medicine, staffing needs, design, clinical and financial benefits, as well as metrics and performance improvement. Part II focuses on the clinical setting and education, with chapters 14 and 15 dedicated to the education of medical students, residents, and fellows. Part III discusses new developments in observation medicine, with chapter 21 devoted to acute medicine, a subspecialty of general (internal) medicine in the United Kingdom, and its role in observation medicine.
Part IV details system-based clinical settings, with topics relevant to cardiac, respiratory, neurological, endocrine, and genitourinary systems, as well as the management of psychosocial and psychiatric problems. It contains up-to-date discussions of the management of common medical emergencies such as deep venous thrombosis, pulmonary embolism, and atrial fibrillation. Pediatric and geriatric populations are also addressed. Emergency departments should be prepared to deal with mass casualties and natural disasters, and a practical resource for disaster management is presented in chapter 61: to develop alternate staffing models aimed at caring for increased numbers of patients with increased needs. The business model (ie, the financial and reimbursement aspects of any subspecialty) is not to be overlooked, and Part V is dedicated to just that. This book is unique in its discussion of international models of observation medicine. Readers may learn from a wide variety of experiences ranging from resource-limited settings such as Colombia or South Africa to contexts with a greater availability of resources such as is the case in some European countries and Australia.
The remaining parts of the book describe the current clinical protocols and administrative policies in both adult and pediatric observation units. Detailed order sets for various clinical scenarios—abdominal pain, chest pain, and asthma, to name a few—are useful as quick reference guides when caring for patients in the observation unit. Management guidelines for highly specific conditions such as snakebites, exposure to environmental toxins, and substance abuse are provided. Psychiatric emergencies, including delirium and panic attacks, are also addressed in a pragmatic fashion. Emergency medicine physicians, residents in emergency medicine, internal medicine, and family practice, internists, nurse practitioners, and physician assistants all will find this book very useful. For hospital administrators, this book is a valuable resource on how to structure and plan for an observation unit.
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