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Effect of a pediatric observation unit on the rate of hospitalization for asthma
S Gouin1, C Macarthur, P C Parkin
1Division of Emergency Medicine, Hospital for Sick Children, University of Toronto, Ontario, Canada.
Insights
An observation unit (OU) in the pediatric emergency department (ED) reduced asthma hospitalizations but increased 72-hour repeat ED visits. This study evaluated the impact of an OU on pediatric asthma care outcomes.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Illness Management
- Healthcare Quality Improvement
Background:
- Acute asthma exacerbations are a common reason for pediatric emergency department (ED) visits.
- Effective management strategies are crucial to reduce hospitalizations and healthcare resource utilization.
- Observation units (OUs) are increasingly implemented in EDs to manage patients requiring extended evaluation.
Purpose of the Study:
- To evaluate the impact of an observation unit (OU) on asthma admission rates.
- To assess changes in the rate of repeat emergency department (ED) visits for asthma within 72 hours post-OU implementation.
- To analyze the effect of the OU on short-stay inpatient admissions for pediatric asthma.
Main Methods:
- A before-and-after study design was employed using retrospective data.
- Subjects included pediatric patients (1-18 years) presenting to an urban tertiary care ED with asthma.
- Data were collected for a pre-OU period (July 1991-June 1992) and a post-OU period (July 1993-June 1994).
Main Results:
- The overall asthma admission rate decreased significantly from 31% pre-OU to 24% post-OU (P < .01).
- Short-term inpatient admissions (less than 24 hours) also decreased from 17% to 10% (P < .01).
- The rate of repeat ED visits within 72 hours for asthma increased from 3% to 5% (P = .01).
Conclusions:
- Implementation of an observation unit in the ED was associated with a reduced hospitalization rate for pediatric acute asthma exacerbations.
- The introduction of the OU led to an increased rate of repeat emergency department visits within 72 hours.
- Further investigation is warranted to understand the reasons for increased repeat visits and optimize care pathways.
Study Objective:
To determine the asthma admission rate and the rate of repeat visits to the emergency department for asthma within 72 hours before and after the introduction of an observation unit (OU). When necessary, admission to the ward from the OU is usually made within 12 hours.
Methods:
We conducted a before-and-after study with retrospective data collection in an urban tertiary care pediatric ED. Our subjects were patients aged 1 to 18 years who presented to the ED with asthma. The pre-OU group comprised patients seen between July 1, 1991, and June 30, 1992, before the opening of the OU. The post-OU group consisted of children seen between July 1, 1993, and June 30, 1994, after the opening of the OU.
Results:
The pre- and post-OU groups had 1,979 and 2,248 asthma visits, respectively. The admission rate decreased from 31% in the pre-OU group to 24% in the post-OU group (P < .01). The frequency of inpatient admissions of less than 24 hours decreased from 17% in the pre-OU group to 10% in the post-OU group (P < or = 01). The rate of repeat ED visits within 72 hours was 3% in the pre-OU group and 5% in the post-OU group (P = .01).
Conclusion:
The use of an OU in the ED was associated with a reduction in the hospitalization rate for children with acute asthma exacerbation. However, we also noted an increased rate of repeat visits to the ED after the introduction of the OU.
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