Leveraging Observation Units for Disaster Response: Cases of Efficient Care Delivery in Disaster Incidents

Emergency department observation units (EDOUs) have been shown to improve hospital operations and capacity during normal operations; however, their role in a disaster or surge event remains unclear. This is a retrospective case series of hospitals that leveraged an EDOU in the setting of a disaster or surge event. Cases were solicited from members of the American College of Emergency Physicians Observation Medicine Section and a review of published literature. Cases were organized under the context of CBRNE (Chemical, Biological, Radiological, Nuclear, Explosives) and environmental disasters. Seven cases were identified across chemical (2), biological (3), and environmental (2) disaster types. In all instances, EDOUs supported continued ED operational flow, enhanced patient surge capacity, and preserved inpatient resources. Five potential models for an EDOU involvement are described: no change, combine disaster and usual patients in the EDOU, only disaster patients in the EDOU, alternative use of the EDOU, and virtual observation care. There was a variable impact of each model on the flow of hospital observation patients and disaster patients. In the setting of a disaster or surge event, the EDOU can play a significant role in ED and hospital operations. Their adaptability, efficiency, and existing infrastructure make them uniquely suited to respond quickly. Opportunities exist for the integration of EDOUs into hospital disaster planning.