Background: Observation units (OU) are being increasingly used within the Emergency Departments (ED) to optimize care and reduce costs, but their use in management of overdose patients is unclear. This study examined demographics, disposition and outcomes for ED overdose patients managed in an OU. We hypothesized that a low-risk ED population with acute drug overdose can safely be managed in an OU.
Methods: This was a secondary analysis of a prospective consecutive cohort of adult (>18) patients presenting to a single ED from March 2015 to September 2018. Overdose patients were screened and included if deemed low-risk for OU management. Exclusion criteria for the cohort included non-drug exposures, alternative diagnosis, chronic toxicity or missing data. OU exclusion criteria for clinical/laboratory abnormalities or high psychiatric risk were pre-specified in a clinical OU pathway. The primary composite study outcome was occurrence of any advanced airway intervention, adverse cardiovascular events (ACVE), or mortality. Secondary outcomes were disposition and return visits.
Results: Of 947 patients screened, 649 were included in the cohort. Of 132 patients requiring additional medical management after the ED visit, 25 (18.9%) were managed in the OU and 107 were admitted. 23 OU patients (92%) were discharged. No patients required airway management. Only two patients (8%) experienced an ACVE (myocardial injury). There were no deaths. Three patients (12%) had 30- day revisits.
Conclusion: In this 3-year consecutive cohort of ED overdose patients, almost one-fifth of patients requiring additional medical management after the ED visit qualified for a low-risk drug overdose OU pathway. Overdoses from a heterogeneous variety of substances were safely managed with acceptably low adverse event rates. Further studies are warranted to improve OU management of low risk ED overdose patients.