Observation-status patients in children's hospitals with and without dedicated observation units in 2011

Michelle L. Macy, Matthew Hall, Elizabeth R. Alpern, Evan S. Fieldston, Leticia A. Shanley, Carla Hronek, Paul D. Hain, Samir S. Shah

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Pages (from-to)366-372
Number of pages7
JournalJournal of Hospital Medicine
Volume10
Issue number6
DOIs
StatePublished - Jun 1 2015

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Observation
Inpatients
Length of Stay
Costs and Cost Analysis
Pediatrics
Health Information Systems
Hospital Units
Hospital Emergency Service
Cross-Sectional Studies
Databases

ASJC Scopus subject areas

  • Health Policy
  • Assessment and Diagnosis
  • Care Planning
  • Fundamentals and skills
  • Leadership and Management

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Macy, M. L., Hall, M., Alpern, E. R., Fieldston, E. S., Shanley, L. A., Hronek, C., ... 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), 366-372. https://doi.org/10.1002/jhm.2339

Observation-status patients in children's hospitals with and without dedicated observation units in 2011. / Macy, Michelle L.; Hall, Matthew; Alpern, Elizabeth R.; Fieldston, Evan S.; Shanley, Leticia A.; Hronek, Carla; Hain, Paul D.; Shah, Samir S.

In: Journal of Hospital Medicine, Vol. 10, No. 6, 01.06.2015, p. 366-372.

Research output: Contribution to journalArticle

Macy, ML, Hall, M, Alpern, ER, Fieldston, ES, Shanley, LA, Hronek, C, Hain, PD & Shah, SS 2015, 'Observation-status patients in children's hospitals with and without dedicated observation units in 2011', Journal of Hospital Medicine, vol. 10, no. 6, pp. 366-372. https://doi.org/10.1002/jhm.2339
Macy, Michelle L. ; Hall, Matthew ; Alpern, Elizabeth R. ; Fieldston, Evan S. ; Shanley, Leticia A. ; Hronek, Carla ; Hain, Paul D. ; Shah, Samir S. / Observation-status patients in children's hospitals with and without dedicated observation units in 2011. In: Journal of Hospital Medicine. 2015 ; Vol. 10, No. 6. pp. 366-372.
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