Comparison of Length of Stay Between Children Admitted to an Observation Versus Inpatient Unit

• Main Author: Lim, Czer Anthoney Enriquez
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01-01-2020
• Subjects: Health sciences; Medicine
• ISBN: 9798641597706

Many pediatric patients requiring admission are otherwise healthy children with self-limited illnesses, making them ideal candidates for care in a pediatric observation unit. Differences in outcomes of admission to a pediatric observation versus a pediatric inpatient unit have not been thoroughly evaluated. In this retrospective cohort study, eligible subjects included children 0-18 years old admitted to observation. The control group consisted of children 0-18 years old admitted to an inpatient unit. Information regarding the current illness, past medical history, and Emergency Department (ED), observation or inpatient unit course was collected. Hospital LOS was analyzed as the primary outcome. Changes in level of care were collected as secondary outcomes. Subgroup analysis was conducted on children presenting with respiratory illnesses. A total of 181 admissions were analyzed, including 92 to observation and 89 to an inpatient unit. The mean LOS was 24.4 hours (SD 13.1) for the observation group and 43.2 hours (SD 25.9) for the inpatient group (p=0.002). Among children admitted for respiratory illnesses, the mean LOS was 32.3 hours (SD 22.7) for the observation group and 48.1 hours (SD 26.1) for the inpatient group (p<0.001). Controlling for factors that varied significantly between the groups, survival analysis demonstrated a 1.95 (1.28, 2.96) fold decrease in time to discharge among children admitted to the observation compared to the inpatient unit (p=0.001) and a 1.85 (1.16, 2.95) fold decrease in time to discharge from the observation compared to the inpatient group for respiratory illnesses (p=0.001) subgroup. Together, the findings suggest that pediatric observation units may provide the means toward efficient, patient-centered care for children with illnesses requiring brief hospitalizations.