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Pediatric observation status beds on an inpatient unit: an integrated care model
Michael T Crocetti1, Michael A Barone, Diane Dritt Amin
1Department of Pediatrics, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA. crocetti@jhmi.edu
Insights
Pediatric observation status (OS) beds successfully managed 75% of patients, with asthma, gastroenteritis, infections, and bronchiolitis being common diagnoses. Bronchiolitis and infectious diseases had higher admission rates compared to gastroenteritis.
Area of Science:
- Pediatric hospital medicine
- Healthcare delivery models
Background:
- Observation status (OS) beds offer an alternative to formal inpatient admission for pediatric patients requiring further evaluation.
- Understanding the utilization and outcomes of OS beds is crucial for optimizing pediatric care pathways.
Purpose of the Study:
- To describe the use of pediatric OS beds in a community hospital setting.
- To identify common diagnoses managed in OS beds and compare admission rates for these conditions.
Main Methods:
- Retrospective chart review of pediatric patients (0-18 years) admitted to OS beds from the emergency department (ED).
- Analysis of patient demographics, diagnoses, time intervals, and disposition (discharge, admission, transfer).
- Comparison of admission rates for the four most frequent diagnoses using relative risk (RR).
Main Results:
- 800 patients were transferred to pediatric OS beds; the most common diagnoses were asthma (27%), gastroenteritis/dehydration (16%), infectious disease (12%), and bronchiolitis (9%).
- 75% of patients were successfully discharged from observation, while 22% required inpatient admission.
- Patients with bronchiolitis (RR 1.92) and infectious diseases (RR 1.35) had significantly higher admission/transfer rates compared to gastroenteritis/dehydration.
Conclusions:
- Pediatric OS beds can be a successful care delivery model in community hospitals.
- Further research is needed to identify specific patient clinical characteristics that would benefit most from this model of care.
Objectives:
Describe the usage of observation status (OS) beds on a pediatric inpatient unit and identify diagnoses likely to be successfully discharged compared to those requiring formal inpatient admission.
Methods:
Retrospective chart review of all patients (0-18 years) transferred to pediatric OS beds from the emergency department (ED) between April 1, 1997 and April 30, 1999. Outcome measures consisted of time interval between ED triage and arrival to an OS bed, total hours in observation, and need for admission or transfer. Using relative risk (RR), we compared admission rates for the 4 most common diagnoses.
Results:
We studied 800 transfers to pediatric OS beds. Asthma (27%), gastroenteritis/dehydration (16%), infectious disease (12%), and bronchiolitis (9%) were the 4 most common diagnoses. There were 597 patients (75%) successfully discharged from observation and 174 (22%) required inpatient admission. Seventeen patients (2%) were transferred to a psychiatric facility and 12 patients (1%) were transferred to a tertiary care center for further evaluation and treatment. Compared to gastroenteritis/dehydration, patients with asthma were just as likely to be admitted/transferred (RR 1.05, 95% CI, 0.87-1.27), those with an infectious disease were 1.3 times more likely to be admitted/transferred (RR 1.35, 95% CI, 1.0-1.83), and those with bronchiolitis were 2 times more likely to be admitted/transferred (RR 1.92, 95% CI, 1.34-2.74).
Conclusions:
We describe the usage of OS beds in a community hospital that we believe can be a successful model for the care of pediatric patients. Future studies are needed to delineate the clinical characteristics of patients that would benefit from this care delivery model.
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