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Factors associated with prolonged stay in a pediatric emergency observation unit of an urban tertiary children's hospital in China.
Pediatr Emerg Care. 2013 Feb; 29(2):183-90.PE

Abstract

OBJECTIVES

This study aimed to examine the factors associated with increased length of stay (LOS > 24 hours) in the pediatric emergency observation unit (OU) of an urban tertiary children's hospital in China.

METHODS

This study was a retrospective cohort study. We retrieved and examined all the records of patients (age, 0-16 years) who were admitted to the OU (n = 10,852) during July 1, 2008, to June 30, 2009. The primary outcome was LOS and prolonged stay (LOS > 24 hours). We also performed a sensitivity analysis by using LOS of 3 days or greater and LOS of 6 days or greater as dependent variables in logistic regression and compared with LOS of greater than 24 hours regression to examine the robustness of the associations.

RESULTS

The overall mean (SD) LOS was 24.0 (24.4) hours; 31.3% had LOS of greater than 24 hours, of which the mean (SD) LOS was 50.2 (28.6) hours. The following factors were associated with LOS of greater than 24 hours: age, 28 days to 3 months (odds ratio, [OR], 1.87; 95% confidence interval, 1.36-2.59) and older than 3 months to 12 months (OR, 1.83; 95% CI, 1.35-2.50) compared with age 0 to 28 days; neurologic diseases (OR, 1.50; 95% CI, 1.31-1.72), infectious diseases (OR, 2.00; 95% CI, 1.61-2.49), and visits for non-respiratory-related signs and symptoms (OR, 2.00; 95% CI, 1.61-2.49); acuity level of emergent (OR, 1.79; 95% CI, 1.57-2.04); procedures (OR, 7.09; 95% CI, 4.16-12.10); emergency transfusions (OR, 1.33; 95% CI, 1.01-1.75); staffed by residents (OR, 1.12; 95% CI, 1.01-1.24); and patients living in low-annual gross domestic product districts (OR, 1.14; 95% CI, 1.01-1.29). Arrival at evening (OR, 0.54; 95% CI, 0.49-0.60) and overnight (OR, 0.43; 95% CI, 0.38-0.49) were less likely to have LOS of greater than 24 hours than arrival during day shifts.

CONCLUSIONS

We identified some risk factors for prolonged stay in an OU. These factors are the starting points in understanding issues related to prolonged stay and are needed to assess efficiency and quality of care in pediatric emergency department and OU. Our results have provided information basis for making improvements in the system and may be important considerations for similar institutions, which encounter similar challenges.

Authors+Show Affiliations

Department of Pediatric Emergency Medicine, Guangzhou Children and Women's Medical Center, Guangzhou, People's Republic of China.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23364384

Citation

Xie, Jianling, et al. "Factors Associated With Prolonged Stay in a Pediatric Emergency Observation Unit of an Urban Tertiary Children's Hospital in China." Pediatric Emergency Care, vol. 29, no. 2, 2013, pp. 183-90.
Xie J, Lin Y, Kissoon N. Factors associated with prolonged stay in a pediatric emergency observation unit of an urban tertiary children's hospital in China. Pediatr Emerg Care. 2013;29(2):183-90.
Xie, J., Lin, Y., & Kissoon, N. (2013). Factors associated with prolonged stay in a pediatric emergency observation unit of an urban tertiary children's hospital in China. Pediatric Emergency Care, 29(2), 183-90. https://doi.org/10.1097/PEC.0b013e3182809b64
Xie J, Lin Y, Kissoon N. Factors Associated With Prolonged Stay in a Pediatric Emergency Observation Unit of an Urban Tertiary Children's Hospital in China. Pediatr Emerg Care. 2013;29(2):183-90. PubMed PMID: 23364384.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Factors associated with prolonged stay in a pediatric emergency observation unit of an urban tertiary children's hospital in China. AU - Xie,Jianling, AU - Lin,Yiqun, AU - Kissoon,Niranjan, PY - 2013/2/1/entrez PY - 2013/2/1/pubmed PY - 2013/11/6/medline SP - 183 EP - 90 JF - Pediatric emergency care JO - Pediatr Emerg Care VL - 29 IS - 2 N2 - OBJECTIVES: This study aimed to examine the factors associated with increased length of stay (LOS > 24 hours) in the pediatric emergency observation unit (OU) of an urban tertiary children's hospital in China. METHODS: This study was a retrospective cohort study. We retrieved and examined all the records of patients (age, 0-16 years) who were admitted to the OU (n = 10,852) during July 1, 2008, to June 30, 2009. The primary outcome was LOS and prolonged stay (LOS > 24 hours). We also performed a sensitivity analysis by using LOS of 3 days or greater and LOS of 6 days or greater as dependent variables in logistic regression and compared with LOS of greater than 24 hours regression to examine the robustness of the associations. RESULTS: The overall mean (SD) LOS was 24.0 (24.4) hours; 31.3% had LOS of greater than 24 hours, of which the mean (SD) LOS was 50.2 (28.6) hours. The following factors were associated with LOS of greater than 24 hours: age, 28 days to 3 months (odds ratio, [OR], 1.87; 95% confidence interval, 1.36-2.59) and older than 3 months to 12 months (OR, 1.83; 95% CI, 1.35-2.50) compared with age 0 to 28 days; neurologic diseases (OR, 1.50; 95% CI, 1.31-1.72), infectious diseases (OR, 2.00; 95% CI, 1.61-2.49), and visits for non-respiratory-related signs and symptoms (OR, 2.00; 95% CI, 1.61-2.49); acuity level of emergent (OR, 1.79; 95% CI, 1.57-2.04); procedures (OR, 7.09; 95% CI, 4.16-12.10); emergency transfusions (OR, 1.33; 95% CI, 1.01-1.75); staffed by residents (OR, 1.12; 95% CI, 1.01-1.24); and patients living in low-annual gross domestic product districts (OR, 1.14; 95% CI, 1.01-1.29). Arrival at evening (OR, 0.54; 95% CI, 0.49-0.60) and overnight (OR, 0.43; 95% CI, 0.38-0.49) were less likely to have LOS of greater than 24 hours than arrival during day shifts. CONCLUSIONS: We identified some risk factors for prolonged stay in an OU. These factors are the starting points in understanding issues related to prolonged stay and are needed to assess efficiency and quality of care in pediatric emergency department and OU. Our results have provided information basis for making improvements in the system and may be important considerations for similar institutions, which encounter similar challenges. SN - 1535-1815 UR - https://www.unboundmedicine.com/medline/citation/23364384/Factors_associated_with_prolonged_stay_in_a_pediatric_emergency_observation_unit_of_an_urban_tertiary_children's_hospital_in_China_ L2 - https://doi.org/10.1097/PEC.0b013e3182809b64 DB - PRIME DP - Unbound Medicine ER -