Observation‐status patients in children's hospitals with and without dedicated observation units in 2011. Issue 6 (5th March 2015)

• Record Type: Journal Article
• Authors: Macy, Michelle L.; Hall, Matthew; Alpern, Elizabeth R.; Fieldston, Evan S.; Shanley, Leticia A.; Hronek, Carla; Hain, Paul D.; Shah, Samir S.
• Is Part Of: Journal of hospital medicine. Volume 10:Issue 6(2015)
• Page Start: 366
• Page End: 372
• Publication Date: 2015-03-05
• Subjects: Hospital care -- Periodicals; Clinical medicine -- Periodicals; 610
• DOI: 10.1002/jhm.2339
• Languages: English
• ISSNs: 1553-5592

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jhm2339-sec-0001" sec-type="section"> <title>BACKGROUND</title> <p>Pediatric observation units (OUs) have demonstrated reductions in lengths of stay (LOS) and costs of care. Hospital‐level outcomes across all observation‐status stays have not been evaluated in relation to the presence of a dedicated OU in the hospital.</p> </sec> <sec id="jhm2339-sec-0002" sec-type="section"> <title>OBJECTIVE</title> <p>To compare observation‐status stay outcomes in hospitals with and without a dedicated OU.</p> </sec> <sec id="jhm2339-sec-0003" sec-type="section"> <title>DESIGN</title> <p>Cross‐sectional analysis of hospital administrative data.</p> </sec> <sec id="jhm2339-sec-0004" sec-type="section"> <title>METHODS</title> <p>Observation‐status stay outcomes were compared in hospitals with and without a dedicated OU across 4 categories: (1) LOS, (2) standardized costs, (3) conversion to inpatient status, and (4) return care.</p> </sec> <sec id="jhm2339-sec-0005" sec-type="section"> <title>SETTING/PATIENTS</title> <p>Observation‐status stays in 31 free‐standing children's hospitals contributing observation patient data to the Pediatric Health Information System database, 2011.</p> </sec> <sec id="jhm2339-sec-0006" sec-type="section"> <title>RESULTS</title> <p>Fifty‐one percent of the 136, 239 observation‐status stays in 2011 occurred in 14 hospitals with a dedicated OU; the remainder were in 17 hospitals without. The percentage of observation‐status same‐day discharges was higher in hospitals with a dedicated OU compared with hospitals without (23.8 vs 22.1, <italic>P</italic> < 0.001), but risk‐adjusted LOS in hours and total standardized costs were similar. Conversion to inpatient status was higher in hospitals with a dedicated OU (11.06%) compared with hospitals without (9.63%, <italic>P</italic> < 0.01). Adjusted odds of return visits and readmissions were comparable.</p> </sec> <sec id="jhm2339-sec-0007" sec-type="section"> <title>CONCLUSIONS</title> <p>The presence of a dedicated OU appears to have an influence on same‐day and morning discharges across all observation‐status stays without impacting other hospital‐level outcomes. Inclusion of location of care (eg, dedicated OU, inpatient unit, emergency department) in hospital administrative datasets would allow for more meaningful comparisons of models of hospital care. <italic>Journal of Hospital Medicine</italic> 2015;10:366–372. © 2015 Society of Hospital Medicine</p> </sec> </abstract>