Objectives: Describe the usage of observation status (OS) beds on a pediatric inpatient unit and identify diagnoses likely to be successfully discharged compared to those requiring formal inpatient admission.
Methods: Retrospective chart review of all patients (0-18 years) transferred to pediatric OS beds from the emergency department (ED) between April 1, 1997 and April 30, 1999. Outcome measures consisted of time interval between ED triage and arrival to an OS bed, total hours in observation, and need for admission or transfer. Using relative risk (RR), we compared admission rates for the 4 most common diagnoses.
Results: We studied 800 transfers to pediatric OS beds. Asthma (27%), gastroenteritis/dehydration (16%), infectious disease (12%), and bronchiolitis (9%) were the 4 most common diagnoses. There were 597 patients (75%) successfully discharged from observation and 174 (22%) required inpatient admission. Seventeen patients (2%) were transferred to a psychiatric facility and 12 patients (1%) were transferred to a tertiary care center for further evaluation and treatment. Compared to gastroenteritis/dehydration, patients with asthma were just as likely to be admitted/transferred (RR 1.05, 95% CI, 0.87-1.27), those with an infectious disease were 1.3 times more likely to be admitted/transferred (RR 1.35, 95% CI, 1.0-1.83), and those with bronchiolitis were 2 times more likely to be admitted/transferred (RR 1.92, 95% CI, 1.34-2.74).
Conclusions: We describe the usage of OS beds in a community hospital that we believe can be a successful model for the care of pediatric patients. Future studies are needed to delineate the clinical characteristics of patients that would benefit from this care delivery model.
Pediatric short stay units are designed to evaluate and treat children who no longer require acute emergency department (ED) care, but who require further observation in a hospital setting due to their medical condition. Patients are considered candidates for the short-stay unit if there is a high likelihood that their medical condition will not require inpatient admission and that the period of observation is predicted to be finite, generally less than 24 hours. During the 1980s, pediatric EDs began designing holding units for asthmatic patients as an alternative to inpatient admission. 1,2 Traditionally, these holding units were physically a part of or adjacent to EDs located within academic tertiary care children's hospitals. 3 Recent information regarding the role of pediatric short stay units in community hospital EDs, a setting where children and adults are often seen in combination, is lacking. Furthermore, community hospitals with adult short stay units tend to exclude pediatric patients. 3 Staff in these units may lack familiarity and experience with pediatric patient care. Therefore, alternative care settings should be considered. In a community hospital, an existing pediatric inpatient unit is one setting that could provide expert child-centered nursing and child life care to observation patients. In this flexible model observation status (OS), beds can be assigned for children thought to require less than 24 hours of treatment. However, if length of stay (LOS) exceeds or is predicted to exceed 24 hours, the patient can be admitted to the unit as an inpatient.
Pediatric inpatient units in community hospitals must contend with marked seasonal variation and frequent census fluctuations. These fluctuations make it difficult to calculate appropriate staffing needs and the cost to keep such units open often comes into question. To optimize usage of pediatric staff and bed space, we designed an integrated care model where pediatric observation patients are cared for in an inpatient setting. The objectives of this study were to describe the usage of pediatric OS beds incorporated into an inpatient unit and compare admission rates for selected medical conditions.