Hospital Observation Services

In hospitals, observation services are mainly referred to as

The use of a bed and periodic monitoring and/or short term treatment by a hospital’s nursing or other staff  (BCBSNC)

Observation is a reasonable and necessary process to evaluate a patient’s condition to determine whether there is a need for the patient to be admitted hence is recognized as an alternative method of evaluation and treatment to inpatient hospitalization. It can even be classified as an outpatient service rather than a hospitalization.

The allocated length of stay at observation services may not be the same in different institutions. Ideally, the earlier a patient is discharged from an observation service, the better. The time allowed at an observation service may vary from few hours to a maximum of about 48 hours. Observations services, in some hospitals may even be developed separately with separate policies for different conditions, while in others common policies with common observations services are also provided. In the Maldives, it is mainly the latter that is practiced.

Different categories of patients can be put under observation for the reasons specified below.

  • Patients who arrive in the hospital in an unstable medical condition would be placed for observation till a definitive care plan can be determined.
  • Patients who develop unusual reactions to procedures and or medicines after minor outpatient surgical procedures are also placed for observation for further assessment and treatment.
  • Diagnostic testing that require a specific preparation or an invasive procedure maybe placed at observation before and after the intervention.
  • Some patients are also placed in observation for planed routine therapeutic services that require the patient to be observed after the treatment.

Given the above categories, patients who utilize the observation services should mainly be discharged after observation. Hospitalization an inpatient should be very low from the observation room.

Utilization statistics of ADK Hospital observation services, Jul-Oct, 2011

At ADK Hospital, the observation services are utilized heavily. As a result the demand for increased observation beds have been almost consistent. In august 2011, the hospital expanded its observation services from 3 beds to 6 beds, a 100% expansion. However, expansion alone is not enough. It is important to assess the utilization of these services. In this regard, an analysis of observation service utilization was assessed.

From July to October, observation service utilization has increased by almost 58% with 184 patients in July to 320 in October. This obviously is a sign of the expansion in beds and hence more patients have benefited from this intervention.

Also, it can be said that the observation service has been managed efficiently. On average, 95% of the patients utilizing observation services were discharged home and only about 5% required an admission. This is a clear sign of proper determination by the clinical staff on who actually requires observation services. The graph shows the utilization of the observation services at ADK Hospital.

In order to keep this service further efficient, a lot needs to be done. Some actions that can be implemented in the near future could be as follows.

  • Improve the current observation service policy by reviewing and strengthening it.
  • Attempt to provide slightly more complex services at observation so that more people can be treated without full hospitalization.
  • Start to take statistics on return rates to observation services or for hospitalization after being released from observation services.

Continuous monitoring and assessment of the service would still be crucial to continuous maintenance of quality of service provided in observation.

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2 Comments on "Hospital Observation Services"

  1. britlin gino
    05/11/2011 at 00:24 Permalink

    good work

  2. Dr Harihar khanal
    19/08/2016 at 15:24 Permalink

    This article clearly depicts the efficiency of a good manager as a whole in implementing, planning, monitoring and evaluation in catering health care services to the public , though the article is focused on ” observation service ” , as a prototype out of a wide range of services provided by the hospital.

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