We implemented a virtual observation unit in which emergency department (ED) patients receive observation-level care at home. Our primary aim was to compare this new care model to in-person observation care in terms of brick-and-mortar ED length of stay (inclusive of ED observation unit time) as well as secondarily on inpatient admission and 72-hour return visits (overall and with admission). In a retrospective analysis of electronic health record data on ED observation patients from January 1, 2022 to December 29, 2022 from an academic urban ED, we used propensity matching to compare virtual to in-person observation patients on outcomes of interest. Patients were matched 1:1 based on age, sex, Charlson Comorbidity Index, and reason for observation. We also conducted real-time review of all virtual observation cases for potential safety concerns. Of 8,218 observation stays, 361 virtual observation patients were matched with 361 in-person observation patients. Virtual observation patients experienced lower median brick-and-mortar ED + EDOU LOS [14.6 (IQR 10.2, 18.9) versus 33.3 (IQR 28.1, 38.1) hours] and lower inpatient admission rates (10.2% [SD 5.0] versus 24.7% [SD 11.3]). The 72-hour return rate was higher for virtual observation patients (3.6% [SD 3.0] versus 2.5% [SD 3.0]). Among those with return visits, the rate of inpatient admission was higher among virtual observation patients (53.8% [SD 3.2] versus 11.1% [13.0]). There were no significant patient safety events recorded. Virtual observation unit patients used fewer hours in ED and ED observation relative to on-site observation patients. This new care delivery model warrants further study because it has the potential to positively impact ED capacity.

中文翻译：

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急诊医学虚拟观察装置的价值


我们建立了一个虚拟观察室，急诊科 (ED) 患者可以在家中接受观察级护理。我们的主要目的是比较这种新护理模式与现场观察护理的实体急诊住院时间（包括急诊观察单位时间）以及住院患者入院和 72 小时回访（总体和入场）。在对 2022 年 1 月 1 日至 2022 年 12 月 29 日来自学术城市 ED 的 ED 观察患者的电子健康记录数据进行回顾性分析中，我们使用倾向匹配来比较虚拟观察患者与现场观察患者的感兴趣结果。根据年龄、性别、查尔森合并症指数和观察原因将患者进行 1:1 匹配。我们还对所有虚拟观察案例进行了实时审查，以排除潜在的安全问题。在 8,218 名观察患者中，361 名虚拟观察患者与 361 名现场观察患者相匹配。虚拟观察患者的实体 ED + EDOU LOS 中位数较低 [14.6 (IQR 10.2, 18.9) 与 33.3 (IQR 28.1, 38.1) 小时] 和较低的住院率 (10.2% [SD 5.0] 与 24.7% [SD]) 11.3]）。虚拟观察患者的 72 小时返回率较高（3.6% [SD 3.0] 对比 2.5% [SD 3.0]）。在回访患者中，虚拟观察患者的住院率较高（53.8% [SD 3.2] vs 11.1% [13.0]）。没有记录重大患者安全事件。与现场观察患者相比，虚拟观察单元患者在急诊室和急诊室观察中使用的时间更少。这种新的护理服务模式值得进一步研究，因为它有可能对急诊科的能力产生积极影响。