Amal Mattu, MD, FAAEM, FACEP, Consulting Editor

In recent years, however, there has been a change in emphasis to increase discharges from the Emergency Department (ED) whenever possible. Financial incentives have pushed more toward outpatient evaluations for initial visits, and monetary penalties are imposed for readmissions of certain conditions within a short time from their recent discharge. It seems that there has also been a cultural shift among patients, who more frequently want to avoid admission as well.

Unfortunately, many acute medical conditions are not quite so amenable to making simple choices of admit versus discharge. Many dispositions fall into the gray area whereby we as clinicians do not feel strongly about a prolonged admission, but we may not feel comfortable with immediate discharge from the ED either. To address this issue, Observation Medicine has emerged as a new area of medicine to address these difficult dispositions. Observation Medicine focuses on caring for the patient during the first 12 to 24 hours prior to discharge. Experts in this field have also developed innovative protocols to initiate care for patients that have traditionally been admitted, but now allow for discharge. For example, patients with low-risk chest pain, new onset atrial fibrillation, or transient ischemic attack can now get expedited workups and care over the course of a short observation stay, and then they can be discharged for further outpatient care. Not only is this care more efficient, but it is also associated with lower health care costs and increased patient satisfaction.

In this issue of Emergency Medicine Clinics of North America , Guest Editors Drs Christopher Baugh and Gentry Wilkerson have assembled a group of experienced and expert physicians in Observation Medicine to discuss this growing and exciting field. Initial articles focus on the history and principles of Observation Medicine as well as how to set up an Observation Unit. Specific medical conditions are then addressed, including cardiovascular, neurologic, infectious, and other areas. An article addresses how to use Observation Medicine to help in caring for extremes of age, and a final article discusses additional conditions amendable to Observation Medicine.

The Guest Editors and authors are to be commended for their innovative and hard work. This issue of Emergency Medicine Clinics of North America represents an invaluable addition to the emergency medicine literature and can serve as a definitive resource to all those that are looking to find more cost-effective and safe ways of managing a potpourri of medical conditions in the ED. I anticipate that within our own ED we will be directly adopting many of the protocols from this text. I hope that all of our readers will take this opportunity to present the ideas contained within to their own administrators and medical directors and work toward creating observation protocols in their EDs. This issue will help in laying the groundwork for future care in the ED.