Management of patients with infectious diseases in an emergency department observation unit.

Pneumonia, cellulitis, and pyelonephritis are discussed in this review because they are the most common infections requiring hospital care, and they all have significant death or complication rates and broad differential diagnoses. They also demonstrate many of the considerations that could be applied to other infections appropriate for OU care. Table 11 lists additional infections that are good candidates for OU care. A key to successful OU management of infection is early consultation with the primary care physicians and appropriate specialists when one is setting up the unit, designing its guidelines, and when treating specific patients. Because individual patient outcomes are not predictable, increasing the absolute numbers treated and successfully discharged from observation can necessarily increase the percentage of OU patients that are hospitalized. In essence, a group who would be hospitalized from the ED is transferred to observation status, where most avoid hospital admission. Because some patients fail to respond, develop complications, or demonstrate alternative diagnoses, many troubles can be avoided when the primary care and specialist physicians have collaborated in the observation treatment decisions. These guidelines have been presented as a starting point. It is clear that more research targeted at this group of patients is required to refine current practice. As for everything else in medicine, there is no doubt that many of the specific recommendations made here will become obsolete in no time.