Research Articles
An observation unit in a pediatric emergency department: One children's hospital's experience*,**,*

https://doi.org/10.1067/men.2002.126669Get rights and content

Abstract

Introduction: The observation unit at The Children's hospital in Denver is a care delivery system which provides expanded ED services to patients. The purposes of this study of the observation unit included: constructing a demographic profile; determining the distribution of admissions by diagnosis and related disposition; and evaluating staffing patterns and nursing workload. Issues related to safety, length of stay, and appropriate utilization were raised as well as the need to accurately identify the most effective nursing staff requirements to provide safe, quality care. Methods: A sample of all patients admitted to the ED observation unit over a 6-month period (686 patients, 4.8% of ED patients) was studied. Descriptive statistics were used to describe the sample of patients. Nurse-to-patient staff ratios were calculated utilizing the BENCHmarking Effort to Network Children's Hospitals parameters. Results: The average age of patients admitted to the observation unit was 4.36 years, equally distributed between males and females. Diagnostic categories were correlated to length of stay. Patients with respiratory illnesses required the longest observation. The majority of patients were discharged home after an average stay of 8.4 hours. Discussion: Study findings inform clinical staffing and formulate guidelines for the ED observation unit usage.

Section snippets

Purpose

The purposes of this study included:

  • 1.

    Constructing a demographic profile of ED observation unit patients;

  • 2.

    Determining the distribution of admissions by diagnosis and related disposition;

  • 3.

    Evaluating average length of stay for the most frequent diagnostic categories;

  • 4.

    Developing a staffing matrix examining nursing workload; and

  • 5.

    Evaluating nurses' perceptions about the observation unit.

Observation units

Few published articles relate to staffing patterns, utilization guidelines, or diagnostic categories of observation units.2, 3, 4 No study has shown whether patients with a broad range of acute illness can be accommodated efficiently and safely in an observation unit with successful cost savings. The literature reveals that an observation unit, or short-stay facility, can provide quality, timely, non-emergent yet acute care in an appropriate venue. Further, such facilities are efficient and

Methodology

In this study of the observation unit, a descriptive retrospective survey design was used with a sample of all patients admitted to the ED observation unit over a 6-month period (October through March, 1998-1999), because it was representative of the average volume of patient visits including the busiest seasonal months. The ED observation unit at Children's Hospital in Denver contains 6 rooms, each with a patient bed or crib, TV, VCR, and recliner, as well as monitoring and resuscitation

Analysis

Descriptive statistics were used for data analysis.

Demographic profile

The total number of patients for whom data were collected was 686, an average of 4.8% of all ED patients. Census predictably increased during the winter months (January, 2917; February, 3299; March, 2993) (Figure 1).

. Patient volume.

Comparing this census with the same months in 2000 and 2001 revealed that use of the observation unit had nearly doubled. Our average patient's age was 4.36 years, with an almost equal number of males and females. The 4 most frequent diagnoses were respiratory

Addendum

The financial charges for care in the observation unit have changed somewhat since the study period. We now classify observation patients as either “obs only” or “admit hold.” These 2 categories let us track whether a patient truly needs to be observed for a length of time, or if they are in fact just waiting for an inpatient bed. Patients are charged as follows: A fixed amount is charged for the first hour of observation, with subsequent hours billed at a lower rate. This is because the first

Acknowledgements

Special thanks to the following people for their invaluable assistance with this study: Marilyn Kent, data base creation; Heidi Luckey, data analysis; Anne Marie Kotzer, RN, PhD, Director, Nursing Research, The Children's Hospital; Joan Bothner, MD, Director, Emergency Department, The Children's Hospital; Meg McCarthy, RN, BSN, BENCH Coordinator, The Children's Hospital.

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    The most common diagnoses were similar to types of pediatric patients treated in our EDOUs today: respiratory, gastroenteritis/dehydration, neurologic, trauma, ingestion, and infections.23–27 In studies of pediatric EDOU patients, respiratory illnesses (most commonly asthma) are the most frequent diagnosis, followed by gastroenteritis/dehydration, whether in a pediatric hospital,28,29 academic general hospital,8 or a community hospital.30 In 1 study, these 2 categories accounted for about 80% of all EDOU patients: respiratory infections (asthma, pneumonia, bronchiolitis, croup) at 41.4% and gastrointestinal illnesses (gastroenteritis/dehydration, abdominal pain) 38%.29

  • Effect of using pediatric emergency department virtual observation on inpatient admissions and lengths of stay

    2014, Academic Pediatrics
    Citation Excerpt :

    In fact, only 18% of observation-eligible visits received ED virtual observation care. Further, our median LOS for ED virtual observation visits was approximately 9 hours, which is low compared with reported mean LOS from geographically distinct pediatric OU of 8 to 20 hours.15–19 Reasons for our relatively shorter LOS may be related to capacity constraints of our 11-bed ED or staff discomfort with longer LOS in the ED as a result of lack of familiarity with providing observation care.

  • The evidence basis for age-related observation care

    2017, Observation Medicine: Principles and Protocols
  • Pediatric observation medicine

    2017, Observation Medicine: Principles and Protocols
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*

Grant awards from the Nursing Research Department of The Children's Hospital and from Sigma Theta Tau (Alpha Kappa Chapter) facilitated data analysis.

**

For reprints, write: Karen LeDuc, RN, MSN, CNS, CPN, 120 So. Grape St, Denver, CO 80246; E-mail: [email protected] .

*

J Emerg Nurs 2002;28:407-13.

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