Pediatric Closed Head Injuries Treated in an Observation Unit

Holsti, Maija; Kadish, Howard A.; Sill, Ben L.; Firth, Sean D.; Nelson, Douglas S.

doi:10.1097/01.pec.0000181426.25342.a9

Cited by 53 publications

(38 citation statements)

References 5 publications

(8 reference statements)

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“…24 Similar to prior studies, 4,15,[25][26][27][28][29][30] our results also indicate that return visits and readmissions following observation are uncommon events. Our findings can serve as initial benchmarks for condition-specific outcomes for pediatric observation care.…”

Section: Discussionsupporting

confidence: 78%

Pediatric observation status: Are we overlooking a growing population in children's hospitals?

Macy

Hall

Shah

et al. 2012

Journal of Hospital Medicine

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BACKGROUND: Inpatient administrative datasets often exclude observation stays, as observation is considered to be outpatient care. The extent to which this status is applied to pediatric hospitalizations is not known. OBJECTIVE: To characterize trends in observation status code utilization and 1‐day stays among children admitted from the emergency department (ED), and to compare patient characteristics and outcomes associated with observation versus inpatient stays. DESIGN: Retrospective longitudinal analysis of the 2004–2009 Pediatric Health Information System (PHIS). SETTING: Sixteen US freestanding children's hospitals contributing outpatient and inpatient data to PHIS. PATIENTS: Admissions to observation or inpatient status following ED care in study hospitals. MEASUREMENTS: Proportions of observation and 1‐day stays among all admissions from the ED were calculated each year. Top ranking discharge diagnoses and outcomes of observation were determined. Patient characteristics, discharge diagnoses, and return visits were compared for observation and 1‐day stays. RESULTS: The proportion of short‐stays (including both observation and 1‐day stays) increased from 37% to 41% between 2004 and 2009. Since 2007, observation stays have outnumbered 1‐day stays. In 2009, more than half of admissions from the ED for 6 of the top 10 ranking discharge diagnoses were short‐stays. Fewer than 25% of observation stays converted to inpatient status. Return visits and readmissions following observation were no more frequent than following 1‐day stays. CONCLUSIONS: Children admitted under observation status make up a substantial proportion of acute care hospitalizations. Analyses of inpatient administrative databases that exclude observation stays likely result in an underestimation of hospital resource utilization for children. Journal of Hospital Medicine 2012; © 2012 Society of Hospital Medicine

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Section: Discussionsupporting

confidence: 78%

Pediatric observation status: Are we overlooking a growing population in children's hospitals?

Macy

Hall

Shah

et al. 2012

Journal of Hospital Medicine

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“…ED-based OUs, which often provide operationally and physically distinct care to observation patients, have been touted as cost-effective alternatives to inpatient care, [18][19][20] resulting in fewer admissions and reductions in length of stay 19,20 without a resultant increase in return EDvisits or readmissions. [21][22][23] Research is needed to determine the patient-level outcomes for short-stay patients in the variety of available treatment settings (eg, physically or operationally distinct OUs and virtual observation), and to evaluate these outcomes in comparison to results published from designated OUs. The operationally and physically distinct features of a designated OU may be required to realize the benefits of observation attributed to individual patients.…”

Section: Discussionmentioning

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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“…18 Among patients with closed head injuries treated in an OU in a pediatric level 1 trauma center, patients with basilar skull fracture, head laceration, or the need for intravenous fluids were more likely to need inpatient admission after OU management. 27 A recent study at a major children' s hospital revealed use of certain resources, including intravenous fluids and medications, cardiorespiratory monitoring, respiratory therapy, subspecialty consultation, and oxygen, were associated with hospitalization. 28 The diagnoses most commonly leading to hospitalization included asthma, adenitis, cellulitis, bronchiolitis, and the presence of esophageal foreign bodies.…”

Section: Measuring and Ensuring Quality Of Care In Ousmentioning

confidence: 99%

Pediatric Observation Units

Conners¹,

Melzer²,

Percelay³

et al. 2012

Pediatrics

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Pediatric observation units (OUs) are hospital areas used to provide medical evaluation and/or management for health-related conditions in children, typically for a well-defined, brief period. Pediatric OUs represent an emerging alternative site of care for selected groups of children who historically may have received their treatment in an ambulatory setting, emergency department, or hospital-based inpatient unit. This clinical report provides an overview of pediatric OUs, including the definitions and operating characteristics of different types of OUs, quality considerations and coding for observation services, and the effect of OUs on inpatient hospital utilization.

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Pediatric Closed Head Injuries Treated in an Observation Unit

Cited by 53 publications

References 5 publications

Pediatric observation status: Are we overlooking a growing population in children's hospitals?

Pediatric observation status: Are we overlooking a growing population in children's hospitals?

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

Pediatric Observation Units

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