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

• Published in: Journal of hospital medicine Vol. 10; no. 6; pp. 366 - 372
• Main Authors: Macy, Michelle L., Hall, Matthew, Alpern, Elizabeth R., Fieldston, Evan S., Shanley, Leticia A., Hronek, Carla, Hain, Paul D., Shah, Samir S.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01-06-2015; Frontline Medical Communications
• Subjects: Adolescent; Child; Child, Preschool; Costs and Cost Analysis; Cross-Sectional Studies; Female; Financial Management, Hospital - methods; Hospital Information Systems - economics; Hospital Information Systems - statistics & numerical data; Hospitals, Pediatric - economics; Hospitals, Pediatric - organization & administration; Hospitals, Pediatric - statistics & numerical data; Humans; Infant; Length of Stay - economics; Length of Stay - statistics & numerical data; Male; Observation - methods; Young Adult
• ISSN: 1553-5592; 1553-5606
• DOI: 10.1002/jhm.2339

BACKGROUND
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.
OBJECTIVE
To compare observation‐status stay outcomes in hospitals with and without a dedicated OU.
DESIGN
Cross‐sectional analysis of hospital administrative data.
METHODS
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.
SETTING/PATIENTS
Observation‐status stays in 31 free‐standing children's hospitals contributing observation patient data to the Pediatric Health Information System database, 2011.
RESULTS
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, P < 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%, P < 0.01). Adjusted odds of return visits and readmissions were comparable.
CONCLUSIONS
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. Journal of Hospital Medicine 2015;10:366–372. © 2015 Society of Hospital Medicine