The Impact of Leveraging an Emergency Department Observation Unit for Pandemic Response on Observation…

Cohort studyJournal of the American College of Emergency Physicians open· Oct 2026

The Impact of Leveraging an Emergency Department Observation Unit for Pandemic Response on Observation Outcomes: A Retrospective Observational Difference-In-Differences Study.

Michael J Carr, Iyesatta M Emeli, Douglas W Chesson … Michael A Ross

Hospital MedicineCohort studyClinical practice

Displacing observation patients to inpatient beds raised odds of inpatient admission during pandemic surge.

The Impact of Leveraging an Emergency Department Observation Unit for Pandemic Response on Observation Outcomes: A Retrospective Observational Difference-In-Differences Study.

Michael J Carr … Michael A Ross

Journal of the American College of Emergency Physicians open · Oct 2026

Purpose

It is unknown what the impact of leveraging an emergency department observation unit (emergency department observation unit) for alternative purposes during a public health emergency might be.

Methods

This is a retrospective observational difference-in-differences study across 4 hospitals within a large academic health system in Atlanta, Georgia.

n = 19,183 control

Results

Higher odds of inpatient admission after displacement; 1.0 would mean no change.

OR 1.74 (95% CI 1.16 to 2.61)

null 1

1.16

2.61

CI excludes the null - significant

More results

Average age was 58 (43 to 72), and 56% were female.

Total cost for the control hospitals remained stable ($3876.6 vs $3997.1; mean ratios =1.03, 95% CI: 0.99-1.08) but increased from $3449.1 to $4645.5 (mean ratios = 1.35, 95% CI: 1.20-1.52) for the intervention hospital.

More results

For total LOS, control hospitals saw a significant decrease in LOS (36.4 h vs 34.3 h, mean ratios = 0.94, 95% CI: 0.90-0.99); the intervention hospital saw a nonsignificant increase (32.1 h vs 36.6 h, mean ratios = 1.14, 95% CI: 1.00-1.30).

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Conclusion

Displacing emergency department observation unit observation patients to inpatient beds to accommodate disaster or surge patients is associated with increases in observation patient cost, LOS, inpatient bed use, and inpatient admission rate.

The Impact of Leveraging an Emergency Department Observation Unit for Pandemic Response on Observation Outcomes: A Retrospective Observational Difference-In-Differences Study.

The Impact of Leveraging an Emergency Department Observation Unit for Pandemic Response on Observation Outcomes: A Retrospective Observational Difference-In-Differences Study.

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