Evaluation of a COVID-19 emergency department observation protocol

Yosef Berlyand; Joshua J Baugh; Andy Hung-Yi Lee; Stephen Dorner; Susan R Wilcox; Ali S Raja; Brian J Yun

doi:10.1016/j.ajem.2022.02.034

Evaluation of a COVID-19 emergency department observation protocol

Am J Emerg Med. 2022 Jun:56:205-210. doi: 10.1016/j.ajem.2022.02.034. Epub 2022 Feb 24.

Authors

Yosef Berlyand¹, Joshua J Baugh¹, Andy Hung-Yi Lee¹, Stephen Dorner¹, Susan R Wilcox¹, Ali S Raja¹, Brian J Yun²

Affiliations

¹ Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, USA.
² Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, USA. Electronic address: byun@mgh.harvard.edu.

Abstract

Objectives: Caring for patients with COVID-19 has resulted in a considerable strain on hospital capacity. One strategy to mitigate crowding is the use of ED-based observation units to care for patients who may have otherwise required hospitalization. We sought to create a COVID-19 Observation Protocol for our ED Observation Unit (EDOU) for patients with mild to moderate COVID-19 to allow emergency physicians (EP) to gather more data for or against admission and intervene in a timely manner to prevent clinical deterioration.

Methods: This was a retrospective cohort study which included all patients who were positive for SARS-CoV-2 at the time of EDOU placement for the primary purpose of monitoring COVID-19 disease. Our institution updated the ED Observation protocol partway into the study period. Descriptive statistics were used to characterize demographics. We assessed for differences in demographics, clinical characteristics, and outcomes between admitted and discharged patients. Multivariate logistic regression models were used to assess whether meeting criteria for the ED observation protocols predicted disposition.

Results: During the time period studied, 120 patients positive for SARS-CoV-2 were placed in the EDOU for the primary purpose of monitoring COVID-19 disease. The admission rate for patients in the EDOU during the study period was 35%. When limited to patients who met criteria for version 1 or version 2 of the protocol, this dropped to 21% and 25% respectively. Adherence to the observation protocol was 62% and 60% during the time of version 1 and version 2 implementation, respectively. Using a multivariate logistic regression, meeting criteria for either version 1 (OR = 3.17, 95% CI 1.34-7.53, p < 0.01) or version 2 (OR = 3.18, 95% CI 1.39-7.30, p < 0.01) of the protocol resulted in a higher likelihood of discharge. There was no difference in EDOU LOS between admitted and discharged patients.

Conclusion: An ED observation protocol can be successfully created and implemented for COVID-19 which allows the EP to determine which patients warrant hospitalization. Meeting protocol criteria results in an acceptable admission rate.

Keywords: COVID-19; Clinical observation units; Emergency department observation; Emergency department operations; SARS-CoV-2.

MeSH terms

COVID-19* / epidemiology
Clinical Observation Units
Emergency Service, Hospital
Humans
Observation
Retrospective Studies
SARS-CoV-2