Observation units: The role of an outpatient extended treatment site in pediatric care

Wiley, James F.; Friday, Janet H.; Nowakowski, Terry; Pittsinger-Kazimer, Lynn; Platt, Ken A.; Scribano, Philip V.

doi:10.1097/00006565-199812000-00019

Cited by 27 publications

(19 citation statements)

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“…[5][6][7] Single-site reports from children's hospitals with successful OUs have demonstrated shorter LOS and lower costs compared with inpatient settings. 6,[8][9][10][11][12][13][14] No prior study has examined hospital-level effects of an OU on observation-status patient outcomes. The Pediatric Health Information System (PHIS) database provides a unique opportunity to explore this question, because unlike other national hospital administrative databases, 15,16 the PHIS dataset contains information about children under observation status.…”

Section: Discussionmentioning

confidence: 99%

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Observation‐status patients in children's hospitals with and without dedicated observation units in 2011

Macy

Hall

Fieldston

et al. 2015

Journal of Hospital Medicine

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Section: Discussionmentioning

confidence: 99%

“…Single‐site reports from children's hospitals with successful OUs have demonstrated shorter LOS and lower costs compared with inpatient settings . No prior study has examined hospital‐level effects of an OU on observation‐status patient outcomes.…”

mentioning

confidence: 99%

Observation‐status patients in children's hospitals with and without dedicated observation units in 2011

Macy

Hall

Fieldston

et al. 2015

Journal of Hospital Medicine

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“…Observation units can be housed in the emergency department (ED)1–3 or on a hospital ward,4,5 blurring the line between outpatient and inpatient settings. Patients report high levels of satisfaction with observation unit stays 6–8.…”

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confidence: 99%

Trends in High-Turnover Stays Among Children Hospitalized in the United States, 1993–2003

Macy¹,

Stanley²,

Lozon³

et al. 2009

Pediatrics

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OBJECTIVE-Brief hospitalizations for children may constitute an opportunity to provide care in an alternative setting such as an observation unit. The goal of this study was to characterize recent national trends in brief inpatient stays for children in the United States.METHODS-Using the Nationwide Inpatient Sample from 1993-2003, we analyzed hospital discharges among children <18 years of age, excluding births, deaths, and transfers. Hospitalizations with lengths of stay of 0 and 1 night were designated as "high turnover." Serial cross-sectional analyses were conducted to compare the proportion of high-turnover stays across and within years according to patient and hospital-level characteristics. Diagnosis-related groups and hospital charges associated with these observation-length stays were examined. RESULTS-In 2003, there were an estimated 441 363 high-turnover hospitalizations compared with 388 701 in 1993. The proportion of high-turnover stays increased from 24.9% in 1993 to 29.9% in 1999 and has remained ≥30.0% since that time. Diagnosis-related groups for high-turnover stays reflect common pediatric medical and surgical conditions requiring hospitalization, including respiratory illness, gastrointestinal/metabolic disorders, seizure/headache, and appendectomy. Significant increases in the proportion of high-turnover stays during the study period were noted across patient and hospital-level characteristics, including age group, payer, hospital location, teaching status, bed size, and admission source. High-turnover stays contributed $1.3 billion (22%) to aggregate hospital charges in 2003, an increase from $494 million (12%) in 1993. CONCLUSIONS-Consistently since 1999, nearly one third of children hospitalized in the UnitedStates experience a high-turnover stay. These high-turnover cases constitute hospitalizations, that may be eligible for care in an alternative setting. Observation units provide 1 model for an efficient and cost-effective alternative to inpatient care, in which resources and provider interactions with patients and each other are geared toward shorter stays with more timely discharge processes. Observation units have widespread use in adult emergency medicine, demonstrating a strong track record with shorter stays and reduced ward admission rates for common conditions such as chest pain, asthma, and cellulitis. [12][13][14][15][16][17][18] Work from McConnochie et al [19][20][21] in the 1990s indicated that a significant number of pediatric hospitalizations could be cared for in an alternative setting, such as an observation unit. Individual institutions have been successful in using pediatric observation units to decrease LOS, 2,4,9,22 reduce admission rates, 5,10,23 and control costs. 2,9 However, little is known about the potential at the national level for children to receive care in an observation unit setting. KeywordsIn this study, we used the Nationwide Inpatient Sample (NIS) over a period of 1 decade to provide national estimates of the number of US children who experi...

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“…26 Implementation of observation units has been suggested as a cost-effective method of caring for asthmatics and other patients who require prolonged ED therapy, but who are expected to be discharged in less than 24 hours. 27,28 Prior studies of the predictive abilities of asthma severity scores have shown that, in general, clinical information at ED presentation does not reliably predict hospital admission, [15][16][17][18][19][20][21][22] successful hospital discharge at 24 hours, 15 or successful discharge from an observation unit. 23 We found that all but one (suprasternal indrawing) of the asthma severity score items from which our two tested severity scores are derived, as well as the scores themselves, were significantly associated with extended treatment; however, the PPVs of individual variables and scores were low.…”

Section: Discussionmentioning

confidence: 99%

Early predictors of admission or prolonged emergency department treatment for children with acute asthma

Shope

Cabana

Zorc

2001

Ambulat Child Health

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ObjectiveTo determine whether demographic, historical and clinical information available at the time of presentation to the pediatric emergency department (ED) can be used to predict which children with acute asthma are likely to require extended treatment (>5 hours in ED or hospital admission). DesignConcurrent cohort study. Setting andInner-city, university-based pediatric ED. Subjects were 1-18 years old sample (n = 181) receiving standardized asthma therapy with frequent beta-agonists and corticosteroids. MeasurementUpon ED presentation, demographic information, asthma history and seven clinical variables were assessed. Bivariate analysis and multivariable logistic regression were used to identify significant predictors of extended treatment.Positive predictive values (PPVs) for individual and combined variables were calculated. ResultsOverall, 30% (54 of 181) subjects required extended treatment; 8% (15 of 181) required treatment in the ED > 5 hours and 22% (39 of 181) were admitted. All but one of the asthma severity score items were significantly associated with prolonged treatment (suprasternal indrawing, P = 0.07; all others, P < 0.05). When these items were combined into the asthma scores from which they were originally derived, PPVs for extended treatment were only 45 and 50%, respectively. These PPVs for extended treatment were no better than those for individual items, which ranged between 36 and 50%. Demographic information and prior asthma history were not associated with extended treatment. Conclusions/Although individual asthma severity score items and asthma severity scores implications for assessed at ED presentation were associated with extended treatment, practice no variable, alone or in combination, had a clinically useful PPV. Decisions regarding observation unit admission for pediatric asthmatics should not solely be based on initial clinical assessment.

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Observation units: The role of an outpatient extended treatment site in pediatric care

Cited by 27 publications

References 0 publications

Observation‐status patients in children's hospitals with and without dedicated observation units in 2011

Observation‐status patients in children's hospitals with and without dedicated observation units in 2011

Trends in High-Turnover Stays Among Children Hospitalized in the United States, 1993–2003

Early predictors of admission or prolonged emergency department treatment for children with acute asthma

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