This chapter discusses the unique opportunities provided by an emergency department-based observation unit in a community hospital based in an urban area. These include the ability to pivot to specific unexpected needs such as a pandemic and providing focused care to a population of geriatric patients. In addition, these units are known to be cost effective and patient customer satisfiers.

There are many hazards of hospitalization of the older and/or frail adult. Observation units (OUs) are a way of delivering high quality care and an appropriate level of care for older adults, while avoiding a long inpatient hospitalization. Successful intervention in a selected group of elderly patients placed in the geriatric OU from the ED can be achieved with the help of a multidisciplinary team approach.

The proportion of the US population over age 65 years has been increasing and is expected to continue to increase. Geriatric patients account for about 20% of emergency department (ED) visits and about 30% of observation unit (OU) patients. A geriatric-focused OU is well suited to serve the needs of the elderly patient. Commonly utilized services include geriatrics, physical therapy, occupational therapy, speech therapy, pharmacists, case managers, and other specialized consultants which may otherwise be difficult to access after-hours or in the ED. Arranging for a comprehensive assessment during a short observation stay avoids an unnecessary and potentially dangerous hospitalization (which exposes vulnerable patients to an increased risk of nosocomial infections, pressure ulcers, deconditioning, deep vein thrombosis, etc.) while still allowing for a period of hospital-based care and observation.