Structure and Function of Observation Units in Children's Hospitals: A Mixed-Methods Study.

Area of Science:

• Pediatric Healthcare Operations
• Hospital Management
• Quality Improvement in Medicine

Background:

• Observation units (OUs) are increasingly used to manage healthcare resources and costs.
• The operational characteristics of pediatric OUs are not well understood.
• This study addresses the gap in knowledge regarding pediatric OU infrastructure and function.

Purpose of the Study:

• To characterize the infrastructure and operational function of pediatric observation units in freestanding children's hospitals.
• To compare the characteristics of hospitals with and without pediatric OUs.
• To identify operational challenges and best practices in pediatric OU management.

Main Methods:

• A survey of 43 freestanding children's hospitals within the Pediatric Health Information System was conducted in 2013.
• Hospitals with OUs admitting unscheduled patients from the emergency department (ED) in 2011 were identified.
• Semistructured interviews were performed with representatives from hospitals with OUs, and data were compared between hospitals with and without OUs.

Main Results:

• 14 of 43 (33%) hospitals had an OU in 2011. Hospitals with OUs had more beds and higher annual ED visits.
• Most OUs were located in the ED, had fewer than 12 beds, and operated as hybrid units (65%) offering scheduled services.
• Admissions were often intuition-based, patient suitability varied, rapid turnover was a focus, and outcome measures were inconsistent. Challenges included copayments and utilization reviews.

Conclusions:

• Pediatric OUs are prevalent in higher-volume hospitals but exhibit significant variation in location, size, and staffing.
• Most OUs function as hybrid units, admitting patients based on intuition with a culture of rapid patient turnover.
• Inconsistent outcome measures and challenges with utilization review and patient copayments highlight areas for improvement in pediatric OU operations.