Management of dyspepsia—The role of the ED Observation unit to optimize patient outcomes

Published:February 03, 2018DOI:



      Dyspepsia is a common complaint that can confer significant burden on one's quality of life and may also be associated with serious underlying conditions. The objective of this study was to determine if patients admitted to the emergency department observation unit (EDOU) for severe or persistent dyspepsia would have cost effective management in terms of investigations performed, length and cost of hospital stay. The secondary objective was to determine if any patient characteristics could predict a need for admission to the inpatient unit.


      Retrospective chart reviews of patients admitted to the EDOU under the Dyspepsia protocol between January 2008 and August 2014 were conducted. Baseline demographics, investigations performed, outcomes related to EDOU stay, admission and 30-day re-presentation outcomes were recorded.


      A total of 1304 patients were included. Median length of stay was 1 day. Cumulative bed-saved days were 38 per month. Two hundred eighteen (16.7%) patients required admission to the inpatient service for further management, while 533 (40.9%) and 313 (24.0%) patients underwent esophagogastroduodenoscopy and hepatobiliary ultrasonography, respectively. No major adverse events were attributed to the EDOU admissions or delays in treatment. No significant clinically relevant factors were associated with a need for admission from the EDOU to the inpatient unit. Median cost of the EDOU admission was approximately one-third that of a similar admission to the inpatient unit.


      The EDOU is an appropriate setting to facilitate investigations and treatment of patients with dyspepsia with considerable bed-saved days.


      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Anon
        Management of dyspepsia: report of a working party.
        Lancet. 1988; 331: 576-579
        • Ford A.C.
        • Marwaha A.
        • Sood R.
        • Moayyedi P.
        Global prevalence of, and risk factors for, uninvestigated dyspepsia: a meta-analysis.
        Gut. 2015; 64: 1049-1057
        • Aro P.
        • et al.
        Functional dyspepsia impairs quality of life in the adult population.
        Aliment Pharmacol Ther. 2011; 33: 1215-1224
        • Bretagne J.F.
        • Honnorat C.
        • Richard-Molard B.
        • Caekaert A.
        • Barthélemy P.
        Comparative study of characteristics and disease management between subjects with frequent and occasional gastro-oesophageal reflux symptoms.
        Aliment Pharmacol Ther. 2006; 23: 607-616
        • Hungin A.P.S.
        • Hill C.
        • Raghunath A.
        Systematic review: frequency and reasons for consultation for gastro-oesophageal reflux disease and dyspepsia.
        Aliment Pharmacol Ther. 2009; 30: 331-342
        • Moayyedi P.M.
        • Lacy B.E.
        • Andrews C.N.
        • Enns R.A.
        • Howden C.W.
        • Vakil N.
        ACG and CAG clinical guideline: management of dyspepsia.
        Am J Gastroenterol. 2017; 112: 988-1013
        • National Institute of Health and Care Excellence
        Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management. NICE guideline (CG 184).
        in: NICE Guidelines. 2014
        • Health Promotion Board
        Singapore Cancer Registry Annual Registry Report Trends in Cancer Incidence in Singapore National Registry of Diseases Office (NRDO).
        in: National Registry of Diseases Office (NRDO). 2014 ([Online]. Available: [Accessed: 21-Oct-2017])
        • Miwa H.
        • et al.
        Asian consensus report on functional dyspepsia.
        J Neurogastroenterol Motil. 2012; 18: 150-168
        • Hostetler B.
        • Leikin J.B.
        • Timmons J.A.
        • Hanashiro P.K.
        • Kissane K.
        Patterns of use of an emergency department-based observation unit.
        Am J Ther. 2002; 9: 499-502
        • Rydman R.J.
        • Roberts R.R.
        • Albrecht G.L.
        • Zalenski R.J.
        • McDermott M.
        Patient satisfaction with an emergency department asthma observation unit.
        Acad Emerg Med. 1999; 6: 178-183
        • Rydman R.J.
        • et al.
        Patient satisfaction with an emergency department chest pain observation unit.
        Ann Emerg Med. 1997; 29: 109-115
        • Ross M.A.
        • et al.
        State of the art: emergency department observation units.
        Crit Pathw Cardiol. 2012; 11: 128-138
        • Baugh C.W.
        • Venkatesh A.K.
        • Bohan J.S.
        Emergency department observation units: a clinical and financial benefit for hospitals.
        Health Care Manage Rev. 2011; 36: 28-37
        • Ross M.A.
        • Hemphill R.R.
        • Abramson J.
        • Schwab K.
        • Clark C.
        The recidivism characteristics of an emergency department observation unit.
        Ann Emerg Med. 2010; 56: 34-41
        • Konnyu K.J.
        • Kwok E.
        • Skidmore B.
        • Moher D.
        The effectiveness and safety of emergency department short stay units: a rapid review.
        Open Medicine. 2012; 6: 10-16
        • Galipeau J.
        • et al.
        Effectiveness and safety of short-stay units in the emergency department: a systematic review.
        Acad Emerg Med. 2015; 22: 893-907
        • Ross M.A.
        • Hockenberry J.M.
        • Mutter R.
        • Barrett M.
        • Wheatley M.
        • Pitts S.R.
        Protocol-driven emergency department observation units offer savings, shorter stays, and reduced admissions.
        Health Aff. 2013; 32: 2149-2156
        • Summers S.M.
        • et al.
        A prospective evaluation of emergency department bedside ultrasonography for the detection of acute cholecystitis.
        Ann Emerg Med. 2010; 56: 114-122
        • Seyedhosseini J.
        • Nasrelari A.
        • Mohammadrezaei N.
        • Karimialavijeh E.
        Inter-rater agreement between trained emergency medicine residents and radiologists in the examination of gallbladder and common bile duct by ultrasonography.
        Emerg Radiol. 2017; 24: 171-176