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Constant Observation Practices in the General Hospital Setting

A National Survey

Received August 11, 1999; revised December 20, 1999; accepted January 12, 2000. From the Department of Psychiatry, University of Arkansas for Medical Sciences; the Department of Psychiatry and Human Behavior, Thomas Jefferson University; and the Department of Psychiatry, University of Massachusetts Medical Center. Address reprint requests to Dr. Worley, UAMS, Department of Psychiatry, 4301 W. Markham, Slot 789, Little Rock, AR 72205; email: WorleyLindaL{at}exchange.uams.edu

The authors conducted a national survey of 355 general medical/surgical hospitals to assess constant observation (CO) practices. The authors assessed overall use, expense, staffing patterns, funding strategies, and cost-saving interventions. Virtually all responding hospitals (N=102) reported using some form of CO. Several hospitals reported significant decreases in CO expenditures after the implementation of cost-saving interventions (the largest annual decrease reported was $340,000). Cost-saving interventions included utilizing consolidated bed spaces, relocating patients near nursing stations, placing at-risk patients in bed enclosure devices, and regularly assisting patients to the toilet. In addition, less costly personnel were hired, and volunteers and/or patient family members provided CO (or were required to assist with the cost of CO). Finally, hospital staff were educated about the costs and the appropriate use of CO. They were also taught to recognize and effectively treat delirium.

Key Words: Constant Observation

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