An observation unit in a pediatric emergency department: one children's hospital's experience

The observation unit at The Children's hospital in Denver is a care delivery system which provides expanded ED services to patients. The purposes of this study of the observation unit included: constructing a demographic profile; determining the distribution of admissions by diagnosis and related disposition; and evaluating staffing patterns and nursing workload. Issues related to safety, length of stay, and appropriate utilization were raised as well as the need to accurately identify the most effective nursing staff requirements to provide safe, quality care.

A sample of all patients admitted to the ED observation unit over a 6-month period (686 patients, 4.8% of ED patients) was studied. Descriptive statistics were used to describe the sample of patients. Nurse-to-patient staff ratios were calculated utilizing the BENCHmarking Effort to Network Children's Hospitals parameters.

The average age of patients admitted to the observation unit was 4.36 years, equally distributed between males and females. Diagnostic categories were correlated to length of stay. Patients with respiratory illnesses required the longest observation. The majority of patients were discharged home after an average stay of 8.4 hours.

Study findings inform clinical staffing and formulate guidelines for the ED observation unit usage.