A national survey of observation units in the United States

Mace, Sharon E.; Graff, Louis; Mikhail, Michael A.; Ross, Michael A.

doi:10.1016/j.ajem.2003.08.012

Cited by 99 publications

(72 citation statements)

References 8 publications

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“…OUs have the ability to improve the quality of care given to patients for the reasons stated above and may reduce inpatient admissions, liability, and healthcare costs [3][4][5]. A national survey of 522 hospitals in 1999 revealed that 19% had an OU, 64% of which admitted pediatric patients, and another 12% planned to open an OU [6]. Although pediatric OUs have existed since the 1970s and are increasing in prevalence, a limited number of studies have been published describing the types of patients admitted to pediatric OUs and their disposition outcomes [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Observation unit experience for pediatric poison exposures

et al. 2009

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Background: Short-Stay Emergency Department Observation Units (OU) are an alternative to hospitalization, but data on OU care of pediatric poisoning exposures is limited. We report the experience of a pediatric OU with this population.Methods: We retrospectively reviewed the charts of children with poison exposure admitted to a pediatric OU during a 30-month period. Data was collected pertaining to demographics, type of exposure, clinical presentation, and rate of hospitalization, and was compared to nonpoisoned OU patients.Results: Of the 91 pediatric patients with poison exposure, 86 complete charts were available for review (94.5%). Of these patients, 49.5% were female, and 82.4% were <6 years of age (range 1.5 months to 16.6 years). There were a total of 98 toxicants implicated, the most common of which were psychoactive drugs (25%) and cardiovascular agents (19%). At OU admission, 33 of 88 patients (38%) had altered mental status or abnormal vital signs. Only 2 of the 53 remaining patients developed abnormal vital signs within the OU. Two patients were hospitalized unexpectedly with respiratory distress due to hydrocarbon and charcoal aspiration pneumonitis, respectively; the unexpected hospitalization rate was 2.2%. Three more planned hospitalizations for endoscopy or psychiatric evaluation led to a total hospitalization rate of 5.4%. This hospitalization rate is significantly lower (RRϭ 0.26, 95% CIϭ 0.11-0.62) than the hospitalization rate from the OU for nonpoisoned patients (20.3%) during that time. Mean OU length of stay for nonadmitted poisoned patients was 14.35 hours. There were no adverse events noted as a result of OU placement.Conclusion: Select poisoned pediatric patients appear suitable for OU management and had less frequent unexpected hospitalization from the OU than other diagnoses.

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Section: Introductionmentioning

confidence: 99%

Observation unit experience for pediatric poison exposures

et al. 2009

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“…14,15 In 2 national surveys of US General Hospitals, 25% provided observation services in beds adjacent to the ED, and the remainder provided observation services in hospital inpatient units. 16,17 However, we are not aware of any previous multi-institution studies exploring hospitalwide practices related to observation care for children.…”

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confidence: 99%

Differences in designations of observation care in US freestanding children's hospitals: Are they virtual or real?

Macy¹,

Hall²,

Shah³

et al. 2011

Journal of Hospital Medicine

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OBJECTIVE:To characterize practices related to observation care and to examine the current models of pediatric observation medicine in US children's hospitals.DESIGN:We utilized 2 web‐based surveys to examine observation care in the 42 hospitals participating in the Pediatric Health Information System database. We obtained information regarding the designation of observation status, including the criteria used to admit patients into observation. From hospitals reporting the use of observation status, we requested specific details relating to the structures of observation care and the processes of care for observation patients following emergency department treatment.RESULTS:A total of 37 hospitals responded to Survey 1, and 20 hospitals responded to Survey 2. Designated observation units were present in only 12 of 31 (39%) hospitals that report observation patient data to the Pediatric Health Information System. Observation status was variably defined in terms of duration of treatment and prespecified criteria. Observation periods were limited to <48 hours in 24 of 31 (77%) hospitals. Hospitals reported that various standards were used by different payers to determine observation status reimbursement. Observation care was delivered in a variety of settings. Most hospitals indicated that there were no differences in the clinical care delivered to virtual observation status patients when compared with other inpatients.CONCLUSIONS:Observation is a variably applied patient status, defined differently by individual hospitals. Consistency in the designation of patients under observation status among hospitals and payers may be necessary to compare quality outcomes and costs, as well as optimize models of pediatric observation care.Journal of Hospital Medicine 2012;. © 2011 Society of Hospital Medicine.

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“…In many ways, poisoned patients are suitable candidates for observation management: (1) the toxicodynamic properties of most toxicants are fairly predictable [11], (2) patients with unknown ingestions or who have ingested a substance with sustained-release properties can be monitored for delayed toxicity [16], (3) the vast majority of these patients are likely to be discharged within 24 h [11,13,14,17], (4) only a small percentage of poisoned patients fail observation and require inpatient admission [11][12][13][14]17], and (5) these patients can receive support to address emotional and psychiatric issues [16]. While the number of dedicated observation units in hospitals is growing across the USA [18,19], very few studies have exclusively evaluated the utilization or experience of observation units for poisoned patients [11][12][13][14]. Findings from these studies, while useful, are limited for several reasons.…”

Section: Discussionmentioning

confidence: 99%

Utilization of Observation Units for the Care of Poisoned Patients: Trends from the Toxicology Investigators Consortium Case Registry

et al. 2015

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Many poisoned patients may only require a period of observation after their exposure. There are limited data describing the use of observation units for managing poisoned adult and pediatric patients. We performed a retrospective review of all patients reported to the ToxIC Case Registry between January 1, 2012 and December 31, 2013. Eligible patients included those who received a bedside consultation by a medical toxicologist and whose care was provided in an observation unit, or those who were admitted under the care of a medical toxicologist in an observation unit. A total of 15,562 poisonings were reported to the registry during the study period, of which 340 (2.2 %) involved patients who were cared for in an observation unit. Of these patients, 22.1 % were 18 years of age or younger, and the remaining 77.9 % were greater than 18 years of age. The most common reason for exposure was the intentional ingestion of a pharmaceutical agent in both adult (30.2 %) and pediatric patients (36.0 %). Alcohols (ethanol) (24.9 %), opioids (20.0 %), and sedativehypnotics (17.7 %) were the most common agent classes involved in adult patient exposures. The most common agent classes involved in pediatric exposures were antidepressants (12.0 %), anticonvulsants (10.7 %), and envenomations (10.7 %). In adult patients, the most common signs and symptoms involved the nervous system (52.0 %), a toxidrome (17.0 %), or a major vital sign abnormality (14.7 %). In pediatric patients, the most common signs and symptoms involved the nervous system (53.3 %), a toxidrome (21.3 %), or a major vital sign abnormality (17.3 %). The results of this study demonstrate that a wide variety of poisoned patients have been cared for in an observation unit in consultation with a boardcertified medical toxicologist. Patterns for the reasons for exposure, agents responsible for the exposure, and toxicological treatments will continue to evolve. Further study is needed to identify better those poisoned patients who can be appropriately managed in an observation unit.

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A national survey of observation units in the United States

Cited by 99 publications

References 8 publications

Observation unit experience for pediatric poison exposures

Observation unit experience for pediatric poison exposures

Differences in designations of observation care in US freestanding children's hospitals: Are they virtual or real?

Utilization of Observation Units for the Care of Poisoned Patients: Trends from the Toxicology Investigators Consortium Case Registry

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