A short stay or 23-hour ward in a general and academic children’s hospital: Are they effective?

Browne, Gary

doi:10.1097/00006565-200008000-00001

Cited by 43 publications

(54 citation statements)

References 20 publications

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“…The overall rate of successful discharge (85%) for observation patients measured in this investigation falls within suggested guidelines 2 but is less than rates described in previous reports from pediatric OUs in North America, 15,16 Australia, 17 and Singapore. 18 This may be attributable, in part, to the use of less conservative admission criteria in the study OU, allowing the admission of patients who are more ill.…”

Section: Discussionsupporting

confidence: 45%

“…18 This may be attributable, in part, to the use of less conservative admission criteria in the study OU, allowing the admission of patients who are more ill. Indirect support for this exists, because the number of observation patients who were admitted to the study OU (580 per 10 000 ED visits) was greater than that reported at similar facilities (545/10 000 in Australia 17 and 400/10 000 in Hartford, CT 16 ). The median age and LOS data for our study population are comparable to previously published reports on pediatric OUs.…”

Section: Discussionmentioning

confidence: 87%

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The Pediatric Hybrid Observation Unit: An Analysis of 6477 Consecutive Patient Encounters

2005

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ABSTRACT. Objectives. Pediatric observation units (OUs) are becoming more common in hospitals throughout the United States, providing physicians with a new disposition option for children who are judged to be too ill for home management. Some OUs function as "hybrid" units, serving both acutely ill and injured observation patients as well as scheduled elective procedure patients. How best to utilize this new resource is not yet defined. We studied the utilization of our pediatric hybrid OU during the first 2 years of operation to determine (1) the spectrum and frequency of diagnoses treated, (2) diagnoses and procedures most (and least) likely to attain discharge successfully within 24 hours, and (3) whether age was associated with inability to be discharged from the OU within 24 hours.Methods. The study setting was a 20-bed hybrid OU located in a pediatric tertiary care hospital in Salt Lake City, Utah. The records of all patients admitted during the first 2 years of OU operation, from August 1999 through July 2001, were examined retrospectively.Results. There were 6477 OU admissions: 4189 (65%) for acutely ill and injured observation patients and 2288 (35%) for scheduled elective procedure patients. For the observation patients, median age was 2.5 years and median length of stay was 15.5 hours. Common admission diagnoses in these patients included enteritis/dehydration (n ‫؍‬ 722), orthopedic injuries (n ‫؍‬ 362), asthma (n ‫؍‬ 327), closed head injury (n ‫؍‬ 289), urgent transfusion/ infusion (n ‫؍‬ 221), bronchiolitis (n ‫؍‬ 212), croup (n ‫؍‬ 207), abdominal pain (n ‫؍‬ 199), cellulitis (n ‫؍‬ 177), and nonfebrile seizure (n ‫؍‬ 98). Overall, 15% of observation patients required subsequent inpatient admission for >24-hour stay. Observation diagnoses that were most likely to require inpatient admission were hematochezia (60%), viral pneumonia (46%), and bronchiolitis (43%). We demonstrated successful OU discharge rates (>85%) for several diagnoses not commonly reported: neonatal hyperbilirubinemia, aseptic meningitis, and diabetic ketoacidosis in the patient with known diabetes. Among the scheduled elective procedure patients, median age was 5.0 years and median length of stay was 3.0 hours. Only 1% of these patients required subsequent inpatient admission. In both populations, age <30 days was associated with increased need for inpatient admission, with a relative risk of 1.9 (95% confidence interval: 1.4 -2.6) among the observation patients and 13.9 (95% confidence interval: 3.0 -65.0) among scheduled procedure patients.Conclusion. Our pediatric hybrid OU played an important role in the treatment of children who were admitted for observation as a result of acute illness or injury, as well as children who required scheduled procedures. For both patient types, we identified diagnoses that are most and least likely to attain successful discharge within 24 hours. The majority (85%) of observation patients were discharged successfully within 24 hours. Successful discharge rates for diagnoses that are not common...

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Section: Discussionsupporting

confidence: 45%

Section: Discussionmentioning

confidence: 87%

The Pediatric Hybrid Observation Unit: An Analysis of 6477 Consecutive Patient Encounters

2005

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“…The spectrum of the cases which presented to the OU in our study (diarrhoea, bronchiolitis, seizures, thallasemia, poisoning/ animal bites, and pneumonia) was similar to those in the previous published literature [1,2,8,9]. The frequency of the unexpected hospitalisations in our study was 9%.…”

Section: Discussionsupporting

confidence: 88%

“…The frequency of the unexpected hospitalisations in our study was 9%. The frequency of the unexpected hospitalisations was 4% to 22% in the previous published studies [6,8,9].…”

Section: Discussionmentioning

confidence: 76%

Unexpected Hospitalisations at a 23-Hour Observation Unit in a Paediatric Emergency Department of Northern India

Mahajan

Arora²,

Kaur³

et al. 2013

JCDR

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Background: The 23-hour Observation Unit (OU) is a novel and an effective means for tackling overcrowding in busy Paediatric Emergency Departments (PED) worldwide. However, unexpected hospitalisations in the OU involve transfer of care and they reduce the efficiency of the OU. Hence, we aimed to study the presenting diagnoses which were responsible for the unexpected hospitalisations in a 23-hour OU. Methods and Design:A prospective cohort study Setting: The PED at a tertiary care teaching hospital. Duration: 15th Feb-15th March 2011.Protocol: Consecutive children were triaged at presentation to the PED, according to the WHO paediatric emergency triage algorithm. Those who were transferred to the 23-hour OU, were further followed up for duration of the stay, the hospital course, and the outcome (discharge/hospitalisation).Results: Three hundred (228 males, 72 females) consecutive children who attended the PED over one month were enrolled. All the children, at presentation, were triaged by the medical intern/s who was/were posted in the PED, and they were crosschecked by a PED consultant. A majority (55%, n=165) of the children were triaged as non-urgent, 32% (n=97) as priority and 13% (n=38) as emergent. Out of the 300 children, 173(58%) were transferred to the 23-hour OU. Of these, 16 (9.1%) required unexpected hospitalisations. The children who required hospitalisations had the following diagnoses: bronchiolitis (4), bronchopneumonia (4), seizure (2), viral hepatitis (2), high fever (1), bronchial asthma (1), severe anaemia (1), and urticaria (1). The mean duration of the stay in the OU was 19 hours for those who needed hospitalisation, as against 13 hours for those who were discharged from the OU. Conclusion:The children with respiratory complaints (bronchiolitis and bronchopneumonia) need frequent monitoring in the 23-hour OU, as they have high hospitalisation rates in the OU.Vidushi Mahajan, suMant arora, tarundeep Kaur, sorab Gupta, Vishal GuGlani

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“…Such practice has been justified by the need for more beds, and decreases in hospital costs (1)(2)(3)(4)(5)(6) , by technological advances in the health area, and risks inherent to hospital admissions (3)(4)(5)(6) .…”

Section: Introductionmentioning

confidence: 99%

O processo de recuperação da criança após a alta hospitalar: revisão integrativa

2010

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Objective: To identify the available knowledge about the process of recovery of hospitalized children and their families after discharge. Methods: Integrative review of literature in databases -national and international -with a qualitative approach. Results: The 16 selected articles belonging to international journals were published between 1990 and 2005; they allowed the identification of the following topics: biopsychosocial manifestations of the child and his family; Biopsychosocial factors related to the manifestations of the child and his family; benefits of early discharge of the child; and, information and support needed. Conclusions: The interventions focused on the child and his family should be started in the hospital check-in in order to improve their ability to cope with the situation. There is need to enhance research on this topic in developing countries, including the prospect of the family as a unit. Keywords: Child, hospitalized; Convalescence; Family; Pediatric nursing; Patient discharge RESUMO Objetivo: Identificar o conhecimento disponível a respeito do processo de recuperação da criança hospitalizada e de sua família após a alta. Métodos: Revisão integrativa da literatura realizada em bases de dados, de âmbito nacional e internacional, com abordagem qualitativa dos dados. Resultados: Os 16 artigos selecionados pertencem a periódicos internacionais, foram publicados entre 1990 a 2005 e permitiram a identificação dos seguintes temas: Manifestações biopsicossociais da criança e da família. Fatores relacionados às manifestações biopsicossociais da criança e da família; Benefícios da alta precoce da criança e Necessidades de informação e apoio. Conclusões: As intervenções voltadas à criança e à família devem ser iniciadas ainda na hospitalização, a fim de melhorar sua capacidade de enfrentamento. Há necessidade de aprimorar as pesquisas sobre essa temática nos países em desenvolvimento incluindo a perspectiva da família como unidade. Descritores: Criança hospitalizada; Convalescença; Família; Enfermagem pediátrica; Alta do paciente RESUMEN Objetivo: Identificar el conocimiento disponible sobre el proceso de recuperación de los niños hospitalizados y sus familias después del alta. Métodos: Revisión integradora de la literatura en bases de datos nacionales e internacionales, con enfoque cualitativo de los datos. Resultados: Los 16 artículos seleccionados pertenecientes a las revistas internacionales, fueron publicados entre 1990 y 2005, estos permitieron identificar los siguientes temas: manifestaciones biopsicosociales del niño y la familia; factores biopsicosociales relacionados con las manifestaciones del niño y la familia; beneficios del alta temprana del niño; y, necesidades de información y apoyo. Conclusiones: Las intervenciones dirigidas al niño y la familia se deben iniciar durante la hospitalización con la finalidad de mejorar su capacidad enfrentamiento. Se concluye, que existe la necesidad de mejorar la investigación sobre este tema en los países en desarrollo, incluyendo la pe...

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A short stay or 23-hour ward in a general and academic children’s hospital: Are they effective?

Cited by 43 publications

References 20 publications

The Pediatric Hybrid Observation Unit: An Analysis of 6477 Consecutive Patient Encounters

The Pediatric Hybrid Observation Unit: An Analysis of 6477 Consecutive Patient Encounters

Unexpected Hospitalisations at a 23-Hour Observation Unit in a Paediatric Emergency Department of Northern India

O processo de recuperação da criança após a alta hospitalar: revisão integrativa

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