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The ageing population of western countries, increasing health demands and crisis of traditional primary care services 1 push more and more patients towards overcrowded emergency departments (EDs). 2 The risks of inappropriate discharges and unnecessary hospitalisations in this context are substantial. In the last decades "observation medicine" 3 has been offered as the solution to balance the limited availability of hospital resources with the need to assess and treat adequately the patients attending the ED. The way in which this practice has evolved has resulted in many local variations as to the naming, acronym and function of dedicated assessment areas. In fact, besides "short observation units"(SOU), "observation wards" or "clinical decision units" (CDU) 4 - 8 where the length of stay is normally <24 h, there are other examples such as "medical admission units" (MAU) or "medical assessment and planning units" (MAPU) 9 10 where the patients can receive a more prolonged assessment and treatment by emergency physicians, internists or multidisciplinary teams. There is reasonable evidence that the chest pain at low or intermediate risk of an acute coronary syndrome can be effectively managed in this way. 11 - 14 Many other common clinical conditions, however, are suitable for a short period of observation and treatment with a good chance of discharging the patient safely. Asthma, 15 16 abdominal traumas, 17 atrial fibrillation, 18 heart failure, 19 syncope, 20 head injuries, 21 some infections 22 and self-harm 23 have been managed in short stay dedicated wards. Nevertheless, multipurpose observation wards have been investigated only through case series with historical controls and a large variability in case mix, length of stay, medical specialties involved and setting. 24 - 26 Little is known about the patients sent home from these units, the consumption of resources and whether any delay in diagnosis and/or treatment occurs. The benefits are not proven but only postulated, as is the effectiveness of current guidelines on their management. A randomised controlled trial could theoretically answer these questions, but its complexity is inherently beyond the scope and capabilities of many non-teaching hospitals such as ours. We have therefore undertaken a "before and after" study to test the reorganisation of our multipurpose SOU, which was operating without rules of admission, clinical policies and strict...