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Observation-status patients in children's hospitals with and without dedicated observation units in 2011.
J Hosp Med. 2015 Jun; 10(6):366-72.JH

Abstract

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.

Authors+Show Affiliations

Departments of Emergency Medicine and Pediatrics, Child Health Evaluation and Research Unit, University of Michigan Medical School, Ann Arbor, Michigan.Children's Hospital Association, Overland Park, Kansas.Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas.No affiliation info availableDepartment of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas.Department of Pediatrics, Cincinnati Children's Hospital and Medical Center, University of Cincinnati School of Medicine, Cincinnati, Ohio.

Pub Type(s)

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

Language

eng

PubMed ID

25755175

Citation

Macy, Michelle L., et al. "Observation-status Patients in Children's Hospitals With and Without Dedicated Observation Units in 2011." Journal of Hospital Medicine, vol. 10, no. 6, 2015, pp. 366-72.
Macy ML, Hall M, Alpern ER, et al. Observation-status patients in children's hospitals with and without dedicated observation units in 2011. J Hosp Med. 2015;10(6):366-72.
Macy, M. L., Hall, M., Alpern, E. R., Fieldston, E. S., Shanley, L. A., Hronek, C., Hain, P. D., & Shah, S. S. (2015). Observation-status patients in children's hospitals with and without dedicated observation units in 2011. Journal of Hospital Medicine, 10(6), 366-72. https://doi.org/10.1002/jhm.2339
Macy ML, et al. Observation-status Patients in Children's Hospitals With and Without Dedicated Observation Units in 2011. J Hosp Med. 2015;10(6):366-72. PubMed PMID: 25755175.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Observation-status patients in children's hospitals with and without dedicated observation units in 2011. AU - Macy,Michelle L, AU - Hall,Matthew, AU - Alpern,Elizabeth R, AU - Fieldston,Evan S, AU - Shanley,Leticia A, AU - Hronek,Carla, AU - Hain,Paul D, AU - Shah,Samir S, Y1 - 2015/03/05/ PY - 2014/11/05/received PY - 2015/02/09/revised PY - 2015/02/10/accepted PY - 2015/3/11/entrez PY - 2015/3/11/pubmed PY - 2016/2/27/medline SP - 366 EP - 72 JF - Journal of hospital medicine JO - J Hosp Med VL - 10 IS - 6 N2 - 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. SN - 1553-5606 UR - https://www.unboundmedicine.com/medline/citation/25755175/Observation_status_patients_in_children's_hospitals_with_and_without_dedicated_observation_units_in_2011_ L2 - https://doi.org/10.1002/jhm.2339 DB - PRIME DP - Unbound Medicine ER -