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[Evaluation of temporary observation and short hospital stay in a pediatric emergency department]
E Guglia1, A G Marchi, G Messi
1Servizio di Pronto Soccorso e Primo Accoglimento, IRCCS Istituto per l'infanzia, Trieste.
Insights
Temporary observation in pediatric emergency departments offers a valuable alternative to hospitalization for children with acute illnesses. This approach reduces hospital admissions and patient discomfort, improving emergency care efficiency.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Observation
- Healthcare Management
Background:
- Temporary observation, a brief emergency department stay, is common for adults but underreported in pediatrics.
- Pediatric patients under 16 with acute conditions are typically admitted for 24-48 hours.
Purpose of the Study:
- To evaluate the effectiveness of temporary observation for children in an emergency department.
- To assess the impact of temporary observation on hospital admission rates and patient outcomes.
Main Methods:
- Retrospective analysis of emergency department activity in 1992 and 1993.
- Comparison of patient demographics, admission rates, and temporary observation utilization.
- Review of clinical evaluation, diagnostic procedures, and treatment for temporary observation patients.
Main Results:
- Temporary observation increased from 274 cases in 1992 to 428 in 1993, despite a decrease in overall emergency visits.
- 94.2% of temporary observation patients stayed less than 6 hours, with 89% discharged home.
- Criteria for temporary observation showed overlap with hospital admission criteria, with noted differences for Central Nervous System and Renal Diseases.
Conclusions:
- Temporary observation is a useful strategy in pediatric emergency care, reducing hospital admissions and patient/family burden.
- Development of clear appropriateness criteria for temporary observation and admission is necessary.
- Guidelines for temporary observation and departmental admission were established based on study findings.
Abstract:
Temporary observation is a very short stay in Emergency Department, widely carried out in adult patients in our Country. No experience in childhood has been reported. In our emergency department children under 16 with acute diseases are admitted for 24-48 hours. From 1991 we carried out also temporary observation. Its effectiveness has been evaluated by studying our activity in 1992 (14.574 emergency room visits, with 664 admissions to our Department and 274 temporary observation) and 1993 (12820 emergency room visits, 573 admissions, 428 temporary observation). Compared to 1992, in 1993 there was a decrease of both emergency room visits (higher than expected from demographic lowering and in part due to payment for emergency room visits) and hospital admissions, and an increase of temporary observation. The stay in hospital was less than 6 hours in 94.2% of temporary observation patients. 18.2% of them were evaluated on clinical basis, 57% also by diagnostic examinations, 24.8% had some treatment. The 89% of the children were sent home following temporary observation, the others were admitted. Criteria for temporary observation were fairly similar to those for hospital admission, but not far as Central Nervous System and Renal Disease are concerned. Our study confirms the usefulness of temporary observation in childhood to reduce both the number of hospital admissions and the discomfort of the patient and his family. Nevertheless there is a need of criteria of appropriateness. Therefore we have elaborated guide lines for temporary observation and admission to our Department.