The Role of the Observation Ward in Enhancing Quality Care and Reducing Inpatient Admission Overload at a Tertiary Care Hospital in Kathmandu, Nepal

Abstract

Introduction:  Observation wards play a critical role in providing timely, efficient, and effective care in emergency departments, especially in tertiary care hospitals, where managing patient flow is essential to prevent inpatient admission overload. This study aimed to assess patient flow through the observation ward of a tertiary care hospital in Kathmandu, Nepal, and to determine the outcomes of these patients.

Methods:  A cross-sectional descriptive study was conducted on all cases admitted to the observation ward over 12 months, from December 2022 to November 2023, at Tribhuvan University Teaching Hospital, Kathmandu. Data were collected from the TUTH Emergency and Observation ward records, and descriptive statistical analysis was performed using SPSS version 20.

Results: During the study period, there were 43,070 emergency department (ED) visits, with 1,911 patients admitted to the observation ward. Of these, 1,631 patients (85.35%) were discharged after being managed in the observation ward. The most common admitting diagnoses were Chronic Obstructive Pulmonary Disease (COPD) (14.75%), Community-Acquired Pneumonia (CAP) (11.09%), and uncontrolled Diabetes Mellitus (DM) (8.37%). The length of hospital stay ranged from 1 to 11 days, with an average length of stay (LOS) of 2.75 days. The turnover rate in the observation ward was 36.36%.

Conclusions: The study highlights the crucial role of the observation ward in managing emergency cases, reducing inpatient admission overload, and providing effective care for common diagnoses such as COPD, CAP, and uncontrolled DM. These findings support the continued use of observation wards to optimize patient flow and resource utilization in tertiary care hospitals.