There has been a steady increase in the use of observation medicine in the emergency department in recent years. There has also been an unfortunate adoption of the use of “observation” to denote patients admitted to the hospital under observation status. Observation medicine is not the same as observation status, and we need to be clear when we use the terms, as they have very different meanings.

Management of transient ischemic attack (TIA) patients in an observation unit (OU) results in reduced risk for subsequent stroke, greater compliance with diagnostic evaluation, shorter length of stay, lower cost, decreased hospital overcrowding and ambulance diversion. OU management should evaluate TIA mimics, differentiate TIA from stroke, and detect high-risk pathologies that require immediate intervention and admission.

We identified three centers in Saudi Arabia that implemented observation units (OUs). The presence of an OU helps with patient flow, reduces overcrowding, enhances patient care, safety and experience, and improves daily key performance indicators. Following this chapter, the authors’ own organizations are keen to develop observation units.

The downside of placing observation patients in general hospital units is discussed. The benefits of using clinical pathways and standard parameters for disposition which fosters nurse-driven care are noted. Observation services are consistent with the hospitalist’s mission of optimizing resource utilization and advancing quality care for patients.

Observation medicine in New Zealand has grown considerably in the last decade, driven by the shorter stays in emergency departments health target and the growth of emergency medicine as a specialty. Evidence that the growth of this service has mostly been appropriate and within suggested guidelines, is indicted by most hospitals admitting < 20% of patients to their emergency medicine governed observation unit and most subsequently admitting < 20% of these to an in-patient ward. Average lengths of stay are less than 12 hours and caseloads commonly include toxicology, low-risk chest pain and abdominal pain although the gamut of minor medical and surgical conditions are seen.

It may be difficult or impossible to obtain a valid history in the emergency. Additional time in the observation unit (OU) may be needed to determine the etiology of the event, whether a seizure or not.

In the OU, there is time for obtain such information, do a diagnostic workup to determine the etiology of the event, whether a seizure or not and if a seizure, determine the precipitating factors and treat them, repeat vital signs and neurologic checks, observe for any recurrent seizures or monitoring if syncope and dysrhythmias are a consideration. If this was a seizure, evaluation can be done, which may involve testing. In a patient with a known seizure disorder, anticonvulsants may be administered, if needed. Precipitating factors, such as infections or electrolyte abnormalities, known to trigger seizures can be treated in the OU. Dizziness has an extensive differntial

This chapter gives the administrative policies that are necessary for starting and maintaining an observation unit.

Emergency department (ED) visits in the United States by patients living with cancer are increasing. although the ED admission rate for this population is higher than for the noncancer population, not all cancer patients require prolonged hospitalization. Observation care offers a promising alternative to admission for the management of many common oncologic emergencies that require care outside the scope of what is achievable during an ED visit.

Dizziness has been classified into 4 subtypes by the neurology literature: presyncope, vertigo, disequilibrium, and lightheadedness. In the ED, because of the often vague presenting symptoms and the extensive differential diagnosis, it is difficult to evaluate dizziness, to determine the correct diagnosis and treatment, and not miss the significant disease processes that require intervention and referral. Additional evaluation in the observation unit including further testing and consultation may be needed in order to accurately diagnose, initiate treatment and properly disposition the patient.

After completing a fellowship in observation medicine with Dr. Graff in Connecticut, USA, Dr. Mahadevan, started the first observation unit (OU) at National University Hospital in Singapore in 2004. After two additional Singapore physicians completed a fellowship with Dr. Mace in Cleveland, Ohio, USA in 2006-2007, additional OUs were started. Currently, there are seven OUs in Singapore. In 2016, the OU became a “hybrid” unit with the admission of pediatric patients above 6 years of age. During the COVID-19 pandemic in early 2020, the OU was converted into a pandemic isolation ward for suspected COVID + patients in order to increase ED capacity. For reimbursement there needed to be the approval from the government that observation patients could use their medical savings called Medisave). Various protocols have been developed including a protocol on the management of primary spontaneous pneumothorax.. One merit of observation medicine has been a reduction in overall length of stay in the hospital, thus freeing up more inpatient beds for the needy and sicker patients.

Headaches are extremely common. Most of the conditions that can lead to a headache are benign and self-limited; although the pathology responsible for some headaches can lead to major complications and even, death if undiagnosed and untreated. Observation unit (OU) management may include diagnostic evaluation to determine an etiology for the headache and initiation of therapy for the headache. Pharmacologic management including combinations of antiemetic, anti-inflammatory and antiepileptic drugs to provide relief of primary headaches and specific therapies for secondary headaches can be initiated in the OU.

Emergency medicine is a main specialty since 1993 in Turkey and has gained momentum since then. Establishing the quality standards of patient transfer and emergency care at an institutional level remains one of its primary purposes. This purpose can be reached by using standard protocols and systematic guidelines. Best practice models for observation medicine in Turkey should be implemented to achieve appropriate use of observational units.