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Case Series of Overdosed Patients Managed in an Observation Unit

Kristen Rizzo, Paul Dominici, Adam Rowden, Jonathan Abraham, Kathryn T Kopec, Henry Swoboda, Milciades A Mirre-Gonzalez, Abdullah Khalid, Kathia Damiron and Chris Villaflor

Background: Observation units (OU) are an increasing aspect of hospitals in the United States. OU provide more efficient use of resources in an increasingly taxed healthcare system. The majority of poisoned patients’ medical issues resolve within 24 hours, making them ideal candidates for an OU. The purpose of this study was to examine the types and safety of overdoses placed in our OU at Einstein Medical Center Philadelphia, an urban, level one trauma center with 100,000 emergency department (ED) visits annually in Philadelphia, Pennsylvania. We hypothesized that the majority of patients admitted to the OU do not require further medical intervention or upgrading to a higher level of care.

Methods: The study is a retrospective chart review of patients with ICD-9 codes associated with overdose or poisoning admitted to our OU between 7/1/10 and 12/31/12. A total of 137 patients were identified, 112 were included. Exclusions were: admission to the hospital prior to transfer to OU (17); transfer to psychiatry (4); miscoded (2); and seen at another site (2). Research associates, reviewed medical charts using a structured data collection form to record disposition, age, gender, etnicity, ingested substances, mental status, medical interventions and any upgrades in disposition.

Results: Between 7/1/10 and 12/31/12 there were 112 patients admitted to the OU. Patient’s age ranged from 17 to 76 years old (mean 38), with 46 males (41%) and 66 females (59%). Ethnicity was mostly African American 73 (65%). A total of 230 different substances were recorded with 61 (26.5%) patients taking more than one intoxicant. The most common overdoses were sedative- hypnotics 66 (28.7%) and antipsychotics 22 (9.6%). Initial OU mental status recorded was: alert and oriented to person, place and time 60 (54%); 46 (41%) sedated, and 6 (5%) confused. The most common medical interventions in the ED were sedatives 18 (16%) and naloxone 12 (10.7%). The most common medical interventions in the OU were: sedatives 24 (21.4%); oxygen 10 (8.9%); and naloxone 5 (4.5%). No intubations or cardiac arrests occurred in the ED or OU. No patients were upgraded to a higher level of care. Seven patients were transferred to psychiatry.

Conclusions: The disposition of stable patients to an OU who present to the ED after overdoses appears to be safe. Understanding the types of overdoses that are safe to be managed in an OU can assist in disposition, patient flow, use of resources, and provide appropriate level of care.