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Comparison of Length of Stay Between Children Admitted to an Observation Versus Inpatient Unit
Czer Anthoney Enriquez Lim, Jennifer Bailey1, Julie Oh
1Department of Pediatrics, University of California at Los Angeles, Los Angeles, CA.
Insights
Pediatric observation units (POUs) offer more efficient care than inpatient units for children needing short hospital stays. This study found POUs significantly reduce length of stay and improve discharge times for pediatric patients.
Area of Science:
- Pediatric hospital medicine
- Healthcare delivery systems
- Clinical outcomes research
Background:
- Many children admitted to hospitals could be managed in pediatric observation units (POUs) instead of traditional inpatient settings.
- The comparative effectiveness of POUs versus inpatient units for pediatric care has not been extensively studied.
Purpose of the Study:
- To evaluate and compare patient outcomes between children treated in pediatric observation units and those in inpatient pediatric units.
- To analyze length of stay and readmission rates as key performance indicators.
Main Methods:
- Retrospective cohort study involving children aged 0-18 years admitted to either a POU or an inpatient unit.
- Data collected included clinical information, medical history, and hospital course.
- Primary outcome was length of stay (LOS); secondary outcomes included conversion to inpatient care and 7-day return to emergency department. Propensity score analysis was employed.
Main Results:
- Mean LOS was significantly shorter in the POU group (24.4 hours) compared to the inpatient group (43.2 hours) (P < 0.01).
- Survival analysis indicated a 1.61-fold shorter time to discharge for observation patients versus inpatient patients (P = 0.02).
- For respiratory illnesses, LOS was 32.3 hours in POUs versus 48.1 hours in inpatient units (P < 0.01), with a 1.70-fold shorter discharge time in POUs (P = 0.03).
Conclusions:
- Pediatric observation units demonstrate potential for efficient care delivery for children with conditions requiring brief hospitalizations.
- Findings suggest POUs can optimize resource utilization in community hospital settings.
- Further prospective studies are recommended to confirm generalizability and long-term outcomes.
Objectives:
Many children who require hospitalization are ideal candidates for care in pediatric observation units (POUs) rather than inpatient pediatric units. Differences in outcomes between children cared for in these 2 practice settings have not been thoroughly evaluated.
Methods:
In this retrospective cohort study, children aged 0 to 18 years admitted to a POU at a community hospital or inpatient unit at a children's hospital were enrolled if they met specific clinical criteria. Information regarding the current illness, medical history, and hospital course was collected. Hospital length of stay (LOS) was analyzed as the primary outcome; secondary outcomes included conversion to inpatient care for the POU group and return to pediatric emergency department within 7 days. Subgroup analysis was conducted on children presenting with respiratory illnesses. Propensity scores were used as a predictor in the final model.
Results:
One hundred eighty-one admissions, 92 to POU and 89 to an inpatient unit, were analyzed. Mean LOS was 24.4 hours (95% confidence interval [CI], 21.7-27.1) for observation and 43.2 hours (95% CI, 37.8-48.6) for inpatient ( P < 0.01). Among the 126 children admitted for respiratory illnesses, the mean LOS was 32.3 hours (95% CI, 26.0-38.6) for observation and 48.1 hours (95% CI, 42.2-54.0) for inpatient ( P < 0.01). Survival analysis demonstrated a 1.61 (95% CI, 1.07-2.42) fold shorter time to discharge among children admitted to observation compared with inpatient ( P = 0.02) and a 1.70 (95% CI, 1.07-2.71) fold shorter time to discharge from observation compared with inpatient for respiratory illnesses ( P = 0.03). Within 7 days of discharge, 2 (2%) patients from the observation group and 1 (1%) from the inpatient group returned to the pediatric emergency department.
Conclusions:
These findings suggest that POU may provide the means toward efficient care for children in community settings with illnesses requiring brief hospitalizations. Future work including prospective investigations is needed to ascertain the generalizability of these findings.
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