ORIGINAL ARTICLE Appropriately Screened Geriatric Chest Pain Patients in an Observation Unit Are Not Admitted at a Higher Rate Than Nongeriatric Patients Troy E. Madsen, MD, Joseph Bledsoe, MD, and Philip Bossart, MD Objective: Observation units may exclude geriatric patients (de- fined as age 65) due to the high rate of observation failure (admission to an inpatient unit) among these patients. We evaluated whether geriatric patients on a chest pain protocol are admitted to an inpatient unit from an emergency department (ED) observation unit at a higher rate than nongeriatric patients. Methods: This was a retrospective chart review of all patients placed in the ED observation unit at the University of Utah Medical Center over a 14-month period from April 2006 to June 2007. The observation unit did not exclude geriatric patients nor did it exclude patients with a history of coronary disease; patients were admitted per the discretion of the attending ED physician. Patient information, including age, date of admission, history of coronary disease (defined as a previous myocar- dial infarction, stent, or coronary artery bypass graft), and admission to an inpatient unit from the observation unit, was recorded. Decision to admit to an inpatient unit was made by the consulting cardiologist. Results were analyzed using  2 statistics. Results: One hundred thirty-four geriatric patients were admitted to the observation unit under the chest pain protocol during the study period. Seventeen percent of these patients were admitted to an inpatient unit from the observation unit versus 10.7% of the 394 chest pain patients who were under age 65 (P = 0.048). Geriatric patients were more likely to have coronary disease (31.3%) than nongeriatric patients (20.8%; P = 0.013). We then performed a subanalysis on the 404 patients (92 geriatric, 312 nongeriatric) who had no history of coronary disease. Geriatric patients without a history of coronary disease had a 12% inpatient admission rate from the observation unit versus a 7.7% admission rate for nongeriatric patients without a history of coronary disease (P = 0.2). Conclusion: Geriatric patients without a history of coronary artery disease were admitted to an inpatient unit at a rate consistent with a generally accepted observation failure rate of 10%. When screened appropriately, these patients may be appropriate for chest pain evaluation in the ED observation unit. Key Words: chest pain, coronary disease, geriatric, observation unit (Crit Pathways in Cardiol 2008;7: 245–247) I ncreasing numbers of geriatric patients create additional burden on the healthcare system, and emergency depart- ment observation units (EDOUs) may present an opportunity for relieving some of this burden. However, without signifi- cant previous experience in observation medicine, it is diffi- cult to know patient populations, which may be best served in an observation unit versus admission to an inpatient unit. Previous studies have shown that EDOUs can be suc- cessful in managing specific patient populations, including low risk chest pain, pediatric dehydration, and asthma. 1–7 Rel- atively little data exist on geriatric chest pain patients (age 65) in EDOUs. One previous study reported an increased inpatient admission rate for geriatric patients admitted to the observation unit for chest pain. 8 We evaluated whether geriatric patients admitted to our observation unit under the chest pain protocol were admitted to the hospital at increased rates compared with younger populations. In the case in which geriatric chest pain patients were admitted to an inpatient unit at a higher rate, we planned to seek to identify a population among geriatric chest pain patients, which would be appropriate for an observation unit. METHODS This study was a retrospective chart review of all patients admitted to the University of Utah Medical Center Emergency Department’s 10-bed observation unit over the 14-month period from April 1, 2006 to June 1, 2007. The University of Utah Emergency Department is an urban emer- gency department with more than 35,000 patient visits per year. The observation unit is under the direction of the emergency physicians and physician assistants. Patients were admitted to the EDOU at the discretion of the attending emergency physician. Inclusion criteria in- cluded: history of chest pain with low suspicion for cardiac etiology, normal or unchanged EKG, and stable vital signs. Exclusion criteria for observation unit placement included: persistent or recurrent significant chest pain, acute coronary syndrome, significantly changed EKG or left bundle branch From the Department of Surgery, Division of Emergency Medicine, Univer- sity of Utah, Salt Lake City, UT. Reprints: Troy E. Madsen, MD, University of Utah, 30 N. 1900 E. 1C26, Salt Lake City, UT 84132. E-mail: troy.madsen@hsc.utah.edu. Copyright © 2008 by Lippincott Williams & Wilkins ISSN: 1535-282X/08/0704-0245 DOI: 10.1097/HPC.0b013e31818efb86 Critical Pathways in Cardiology • Volume 7, Number 4, December 2008 245