14505 TOSHIYA MITSUNAGA

Tagged in ED Organisations, Management

Characteristic of the patients who are hospitalized to Emergency Department Observation Units (EDOUs) in Japan.

Introduction: Recently, it becomes serious problem that it is very difficult to transport elderly patients to emergency department in Japan. The average time from emergency call to arrival at hospital becomes longer. In the United States and in other some developed countries, Emergency Department Observation Units (EDOUs) has been introduced to manage emergency departments smoothly. Also in Japan, many emergency departments introduced EDOUs, however it is still uncertain the usefulness of EDOUs for management of elderly patients. The purpose of this study is to analyze data of patients who were hospitalized to EDOUs in our hospital and to examine the usefulness of EDOUs.

Methods: We followed 1,426 patients who were hospitalized in our EDOUs from January 1, 2011 to December 31, 2014.

Results: The average age was increasing and the average hospitalized length become shorter during 2011 to 2014. The proportion of over 65 years old slightly increased 36.42% (2011 to 2012) to 37.73% (2013 to 2014), but there was no significant difference (p=0.61). The average hospitalized length of patients over 65 years old was 2.16 ± 0.91 days, and this is significantly longer than that of patients under 65 years old (1.92 ± 0.82 days). The proportion of orthopedic disease was about 36 percent in over 65 years old and it was the largest. Moreover, the proportion of traumatic disease was 59 percent. Compared to patients under 65 years old, this proportion was significantly higher (the proportion of orthopedic disease/ traumatic disease: 23%/47%). Most of elderly patients with orthopedic disease adapted for surgery were transferred to other hospitals in a few days.

Discussion: In a report by Ogawa et al, it showed that extension factors of the hospitalized length in elderly patients were complications and worsening of other disease. In addition, Yoshida et al reported that they found exacerbation of the original disease in 16% of elderly patients, and in 10.4% of elderly patients complicated with physical complications after hospitalization. In our study, patients over 65 years old who were hospitalized for traumatic disease had many endogenous complications such as pneumonia, urinary tract infections, and arrhythmias at the time of hospitalization. Therefore, it suggests that physical factors may have influenced the hospitalized length of elderly patients. 

Conclusion: Our study showed that old patients are hospitalized in EDOUs for trauma, and they stay in EDOUs longer because of complications. EDOUs at university hospital has some benefit for emergency medical system in Japan, where the population of old patients is high.