A short stay or 23-hour ward in a general and academic children's hospital: Are they effective?

Objective: We evaluated the usefulness of a short stay or 23-hour ward in a pediatric unit of a large teaching hospital, Westmead Hospital, and an aca demic Children's hospital, The New Children's Hospital, to determine if the y are a useful addition to the emergency service. Methods: This is a descriptive comparison of prospectively collected data o n all children admitted to the short stay ward at Westmead Hospital (WH) du ring 1994 and the short stay ward at the New Children's Hospital (NCH) duri ng 1997-98. These hospitals service an identical demographic area with the latter (NCH) a tertiary referral center. The following outcome measures wer e used: length of stay, appropriateness of stay, rate of admission to an in -hospital bed, and rate of unscheduled visits within 72 hours of discharge. Adverse events were reported and patient follow-up was attempted at 48 hou rs after discharge in all cases. Results: The short stay ward accounted for 10.3% (Westmead Hospital) and 14 .7% (New Children's Hospital) of admissions, with 56% medical in nature, 30 % surgical, and the remainder procedural or psychological. Admission patter ns were similar, with asthma, gastroenteritis, convulsion, pneumonia, and s imple surgical conditions accounting for most short stay ward admissions. T he short stay ward increased hospital efficiency with an average length of stay of 17.5 hours (Westmead Hospital) compared to 20.5 hours (New Children 's Hospital), The users of the short stay ward were children of young age l ess than 2 years, with stay greater than 23 hours reported in only 1% of al l admissions to the short stay ward. The rate of patient admission to an in -hospital bed was tow, (4% [Westmead Hospital] compared to 6% [New Children 's Hospital]), with the number of unscheduled visits within 72 hours of sho rt stay ward discharge less than 1%, There were no adverse events reported at either short stay ward, with parental satisfaction high. The short stay ward was developed through reallocation of resources from within the hospit al to the short stay ward. This resulted in estimated savings of $1/2 milli on (Westmead Hospital) to $2.3 million (New Children's Hospital) to the hos pital, due to more efficient bed usage. Conclusion: This data demonstrates the robust nature of the short stay ward . At these two very different institutions we have shown improved bed effic ient and patient care in a cost-effective way, We have also reported on gre ater parental satisfaction and early return of the child with their family to the community.