Use of an observation unit by a pediatric emergency department for common pediatric illnesses

Objective: To describe the use of a pediatric observation unit (OU), includ ing relapse rates for common pediatric illnesses, and to assess effectivene ss of OU utilization. Design: Retrospective, cohort of all emergency department (ED) visits, OU a nd inpatient unit (IU) admissions. Setting: Tertiary care children's hospital. Participants: All children evaluated in the ED and subsequently admitted to either the OU or IU over a 2-year period. Main Outcome Measure: Rates with 95% confidence intervals (CI) for OU use a nd need for subsequent IU admission from OU, and odds ratios (OR) with 95% CI for use of the OU for specific pediatric disorders. Results: During 10/1/96-9/30/98, there were 44,459 ED visits, 1798 (4.0%) O U admissions, and 3241 (7.3%) inpatient admissions (IA) from the ED. OU mea n length of stay was 15.6 +/- 6.1 hours; mean age was 6 +/- 5.3 years with 31% under 2 years of age. Of the total admissions (IU and OU), diagnoses wi th high OU utilization were: asthma 274/575,48%; croup 76/125,61%; enteriti s/dehydration 284/470, 60%; poisonings 82/118, 70%; and seizures 80/204, 39 %. The likelihood of an OU admission for these illnesses versus IU (adjuste d for subsequent need for IU admission) was: asthma OR 1.3 (1.1, 1.5), P < 0.005; croup OR 2.3 (1.6, 3.3), <0.001; enteritis/ dehydration OR 2.8 (2.1, 3.0), P < 0.001; poisonings OR 3.8 (2.5, 5.7), P < 0.001; and seizures OR 0.8 (0.6,1.2), P = 0.28. For these diagnoses, OU admissions resulting in IU admission occurred for asthma 45/274, 16.4%; croup 7/76, 9.2%; enteritis/ dehydration 13/284, 4.6%; poisonings 3/82, 3.7%; and seizures 15/80, 18.8%, resulting in an overall need for further hospitalization to the IU for the se diagnoses of 83/796, 10.4%, (95% CI 8.3, 12.6). Conclusion: Admissions to the observation unit comprised over one third of all admissions from a pediatric ED. Certain pediatric illnesses appear to b e well suited for admission to the observation unit, with low likelihood of the need for subsequent admission to the inpatient unit. Given the current trends in third-party payer reimbursements for short (<24 hours) admission s, observation unit use provides a more attractive alternative to inpatient admission for many pediatric patients.