Pediatric observation units in the United States: a systematic review.
BACKGROUND
As more efficient and value-based care models are sought for the US healthcare system, geographically distinct observation units (OUs) may become an integral part of hospital-based care for children.


OBJECTIVE
To systematically review the literature and evaluate the structure and function of pediatric OUs in the United States.


METHODS
Searches were conducted in Medline, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Health Care Advisory Board (HCAB), Lexis-Nexis, National Guideline Clearinghouse, and Cochrane Reviews, through February 2009, with review of select bibliographies.


METHODS
English language peer-reviewed publications on pediatric OU care in the United States.


METHODS
Two authors independently determined study eligibility. Studies were graded using a 5-level quality assessment tool. Data were extracted using a standardized form.


RESULTS
A total of 21 studies met inclusion criteria: 2 randomized trials, 2 prospective observational, 12 retrospective cohort, 2 before and after, and 3 descriptive studies. Studies present data on more than 22,000 children cared for in OUs, most at large academic centers. This systematic review provides a descriptive overview of the structure and function of pediatric OUs in the United States. Despite seemingly straightforward outcomes for OU care, significant heterogeneity in the reporting of length of stay, admission rates, return visit rates, and costs precluded our ability to conduct meta-analyses. We propose standard outcome measures and future directions for pediatric OU research.


CONCLUSIONS
Future research using consistent outcome measures will be critical to determining whether OUs can improve the quality and cost of providing care to children requiring observation-length stays.
Division of General Pediatrics, Child Health Evaluation and Research Unit, University of Michigan, Ann Arbor, Michigan 48109-5456, USA. mlmacy@umich.edu
Michelle L
ML
Macy
Christopher S
CS
Kim
Comilla
C
Sasson
Marie M
MM
Lozon
Matthew M
MM
Davis
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016206:Databases, Bibliographic; D006757:Hospital Units; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019370:Observation / Q000379:methods*; D010372:Pediatrics / Q000379:methods*; D014481:United States