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Effect of using pediatric emergency department virtual observation on inpatient admissions and lengths of stay.
Acad Pediatr. 2014 Sep-Oct; 14(5):510-6.APed

Abstract

OBJECTIVE

To determine whether using emergency department (ED) virtual observation for select pediatric conditions decreases admission rates for these conditions, and to examine effects on length of stay.

METHODS

The option of ED virtual observation care for 9 common pediatric conditions was introduced in 2009; associated order sets were developed. Retrospective secondary analyses of administrative data from our tertiary care pediatric ED and children's hospital were performed for the year before (year 0) and after (year 1) this disposition option was introduced. The proportion of visits admitted to the inpatient unit and length of stay (LOS) were determined for all visits considered eligible for ED virtual observation care on the basis of diagnosis codes for both study years.

RESULTS

There were 1614 observation-eligible visits in year 0 and 1510 in year 1. In year 1, 18% (n = 266) of observation-eligible visits received ED virtual observation care. Admission rates for observation-eligible visits were similar after this model of care was introduced (25% year 0, 29% year 1, P = .02). Median LOS for ED virtual observation visits was 8.8 hours (interquartile range 6.5-12.4). ED LOS was shorter for ED discharges (5.6 hours year 0, 5.1 hours year 1, P < .001) and unchanged for admissions (6.0 hours year 0, 5.8 hours, year 1, P = .41) after introducing ED virtual observation.

CONCLUSIONS

Admission rates for observation-eligible visits were not lower in the year after ED virtual observation care was introduced. LOS decreased for ED discharges and was unchanged for admissions. Reevaluation of the effects of pediatric ED virtual observation on admission rates and LOS after longer periods of use is indicated.

Authors+Show Affiliations

Department of Emergency Medicine, University of Michigan, Ann Arbor, Mich; Department of Pediatrics, University of Michigan, Ann Arbor, Mich. Electronic address: acator@med.umich.edu.Wayne State University School of Medicine, Detroit, Mich.Department of Emergency Medicine, University of Michigan, Ann Arbor, Mich; Department of Pediatrics, University of Michigan, Ann Arbor, Mich.Department of Emergency Medicine, University of Michigan, Ann Arbor, Mich; Division of General Pediatrics, Department of Pediatrics, Child Health Evaluation and Research Unit, University of Michigan, Ann Arbor, Mich.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25169162

Citation

Cator, Allison D., et al. "Effect of Using Pediatric Emergency Department Virtual Observation On Inpatient Admissions and Lengths of Stay." Academic Pediatrics, vol. 14, no. 5, 2014, pp. 510-6.
Cator AD, Weber JS, Lozon MM, et al. Effect of using pediatric emergency department virtual observation on inpatient admissions and lengths of stay. Acad Pediatr. 2014;14(5):510-6.
Cator, A. D., Weber, J. S., Lozon, M. M., & Macy, M. L. (2014). Effect of using pediatric emergency department virtual observation on inpatient admissions and lengths of stay. Academic Pediatrics, 14(5), 510-6. https://doi.org/10.1016/j.acap.2014.03.010
Cator AD, et al. Effect of Using Pediatric Emergency Department Virtual Observation On Inpatient Admissions and Lengths of Stay. Acad Pediatr. 2014 Sep-Oct;14(5):510-6. PubMed PMID: 25169162.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of using pediatric emergency department virtual observation on inpatient admissions and lengths of stay. AU - Cator,Allison D, AU - Weber,Julie S, AU - Lozon,Marie M, AU - Macy,Michelle L, PY - 2013/11/14/received PY - 2014/03/09/revised PY - 2014/03/12/accepted PY - 2014/8/30/entrez PY - 2014/8/30/pubmed PY - 2015/10/7/medline KW - child KW - delivery of health care KW - emergency department KW - length of stay KW - observation medicine SP - 510 EP - 6 JF - Academic pediatrics JO - Acad Pediatr VL - 14 IS - 5 N2 - OBJECTIVE: To determine whether using emergency department (ED) virtual observation for select pediatric conditions decreases admission rates for these conditions, and to examine effects on length of stay. METHODS: The option of ED virtual observation care for 9 common pediatric conditions was introduced in 2009; associated order sets were developed. Retrospective secondary analyses of administrative data from our tertiary care pediatric ED and children's hospital were performed for the year before (year 0) and after (year 1) this disposition option was introduced. The proportion of visits admitted to the inpatient unit and length of stay (LOS) were determined for all visits considered eligible for ED virtual observation care on the basis of diagnosis codes for both study years. RESULTS: There were 1614 observation-eligible visits in year 0 and 1510 in year 1. In year 1, 18% (n = 266) of observation-eligible visits received ED virtual observation care. Admission rates for observation-eligible visits were similar after this model of care was introduced (25% year 0, 29% year 1, P = .02). Median LOS for ED virtual observation visits was 8.8 hours (interquartile range 6.5-12.4). ED LOS was shorter for ED discharges (5.6 hours year 0, 5.1 hours year 1, P < .001) and unchanged for admissions (6.0 hours year 0, 5.8 hours, year 1, P = .41) after introducing ED virtual observation. CONCLUSIONS: Admission rates for observation-eligible visits were not lower in the year after ED virtual observation care was introduced. LOS decreased for ED discharges and was unchanged for admissions. Reevaluation of the effects of pediatric ED virtual observation on admission rates and LOS after longer periods of use is indicated. SN - 1876-2867 UR - https://www.unboundmedicine.com/medline/citation/25169162/Effect_of_using_pediatric_emergency_department_virtual_observation_on_inpatient_admissions_and_lengths_of_stay_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1876-2859(14)00093-X DB - PRIME DP - Unbound Medicine ER -