Short-stay units and observation medicine: a systematic review

Objectives: To conduct a systematic review of how short-stay observation units (SOUs) affect the efficiency of healthcare delivery and the quality of services provided. Data sources: MEDLINE, CINAHL, Best Evidence and The Cochrane Library were searched for the period 1 January 1960 to 31 July 2000. Study selection: Studies were eligible if published in English and rated at National Health and Medical Research Council evidence levels 1, II-1, II-2, or II-3; 12 comparative studies published between 1985 and 1998 met these criteria. Data extraction: Data pertaining to clinical outcomes, length of stay, re-presentation rates, emergency department efficiency and costs of care were extracted and evaluated independently. Data synthesis: As there was considerable heterogeneity in the patient populations and outcomes, results were summarised rather than subjected to meta-analysis. Conclusion: SOUs have the potential to increase patient satisfaction, reduce length of stay, improve the efficiency of emergency departments and improve cost effectiveness. However, SOUs have commonly been implemented alongside new clinical protocols, and it is not possible to distinguish the relative benefits of each. As demand increases, providing effective and cost-efficient care will become increasingly important. SOUs may help organisations that are attempting to streamline patient care while maintaining their quality of service delivery.