Hold a Patient in the Observation Unit

The observation unit is the ED’s short-stay area: a place to keep a patient for a few hours of monitoring when they are not sick enough to admit and not yet safe to send home — for example, someone needing serial troponins after chest pain, or a patient sleeping off a sedative. Each observation entry records the bay, why they are being watched, for how long, the plan, and a status the team can update as things change.

Who / when: the ED nurse or ED physician places a patient into observation and updates their status while they are watched. We follow Grace Okoro holding a chest-pain patient for serial troponins.

1. ED nurse — open Emergency → Observation. The screen lists everyone currently under observation; search by patient or reason.
2. ED nurse — press “Add To Observation”. Search for the patient, set the bay (e.g. “Obs 1”), the reason, the expected hours, and the plan (e.g. “Serial troponin”).
3. ED nurse — set the status — Monitoring, Stable or Escalate — and Add. The patient appears on the list and in the Observation zone on the bed and zone board.
4. ED nurse / physician — update the status as the picture changes; Escalate flags a patient who is deteriorating and needs to move out of observation.

Note

Observation is a holding state inside the ED, not a ward admission. When the observation period ends, the patient still needs a disposition — discharge if they are now safe, or admit if they need a bed.

What happens next

An observation patient who stabilises is discharged; one who deteriorates is escalated and usually admitted. Either way the decision is recorded on the Disposition screen.

Follow the trail

• Previous: Fast-Track a Minor Injury
• Next: Disposition a Patient
• Related: Work the Bed and Zone Board