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Pediatric observation status: are we overlooking a growing population in children's hospitals?
J Hosp Med. 2012 Sep; 7(7):530-6.JH

Abstract

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.

Authors+Show Affiliations

Department of Emergency Medicine and the Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, MI, USA. mlmacy@umich.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22371384

Citation

Macy, Michelle L., et al. "Pediatric Observation Status: Are We Overlooking a Growing Population in Children's Hospitals?" Journal of Hospital Medicine, vol. 7, no. 7, 2012, pp. 530-6.
Macy ML, Hall M, Shah SS, et al. Pediatric observation status: are we overlooking a growing population in children's hospitals? J Hosp Med. 2012;7(7):530-6.
Macy, M. L., Hall, M., Shah, S. S., Harding, J. P., Del Beccaro, M. A., Hain, P. D., Hronek, C., & Alpern, E. R. (2012). Pediatric observation status: are we overlooking a growing population in children's hospitals? Journal of Hospital Medicine, 7(7), 530-6. https://doi.org/10.1002/jhm.1923
Macy ML, et al. Pediatric Observation Status: Are We Overlooking a Growing Population in Children's Hospitals. J Hosp Med. 2012;7(7):530-6. PubMed PMID: 22371384.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pediatric observation status: are we overlooking a growing population in children's hospitals? AU - Macy,Michelle L, AU - Hall,Matthew, AU - Shah,Samir S, AU - Harding,John P, AU - Del Beccaro,Mark A, AU - Hain,Paul D, AU - Hronek,Carla, AU - Alpern,Elizabeth R, Y1 - 2012/02/27/ PY - 2011/11/03/received PY - 2012/01/19/revised PY - 2012/01/21/accepted PY - 2012/2/29/entrez PY - 2012/3/1/pubmed PY - 2013/2/7/medline SP - 530 EP - 6 JF - Journal of hospital medicine JO - J Hosp Med VL - 7 IS - 7 N2 - 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. SN - 1553-5606 UR - https://www.unboundmedicine.com/medline/citation/22371384/Pediatric_observation_status:_are_we_overlooking_a_growing_population_in_children's_hospitals L2 - https://doi.org/10.1002/jhm.1923 DB - PRIME DP - Unbound Medicine ER -