title: Unexpected hospitalisations at a 23-hour observation unit in a paediatric emergency department of northern India.
abstract: BACKGROUND
  The 23-hour Observation Unit (OU) is a novel and an effective means for tackling overcrowding in busy Paediatric Emergency Departments (PED) worldwide. However, unexpected hospitalisations in the OU involve transfer of care and they reduce the efficiency of the OU. Hence, we aimed to study the presenting diagnoses which were responsible for the unexpected hospitalisations in a 23-hour OU.
  
  
  METHODS
  A prospective cohort study Setting: The PED at a tertiary care teaching hospital.
  
  
  METHODS
  15th Feb-15th March 2011.
  
  
  METHODS
  Consecutive children were triaged at presentation to the PED, according to the WHO paediatric emergency triage algorithm. Those who were transferred to the 23-hour OU, were further followed up for duration of the stay, the hospital course, and the outcome (discharge/hospitalisation).
  
  
  RESULTS
  Three hundred (228 males, 72 females) consecutive children who attended the PED over one month were enrolled. All the children, at presentation, were triaged by the medical intern/s who was/were posted in the PED, and they were crosschecked by a PED consultant. A majority (55%, n=165) of the children were triaged as non-urgent, 32% (n=97) as priority and 13% (n=38) as emergent. Out of the 300 children, 173(58%) were transferred to the 23-hour OU. Of these, 16 (9.1%) required unexpected hospitalisations. The children who required hospitalisations had the following diagnoses: bronchiolitis (4), bronchopneumonia (4), seizure (2), viral hepatitis (2), high fever (1), bronchial asthma (1), severe anaemia (1), and urticaria (1). The mean duration of the stay in the OU was 19 hours for those who needed hospitalisation, as against 13 hours for those who were discharged from the OU.
  
  
  CONCLUSIONS
  The children with respiratory complaints (bronchiolitis and bronchopneumonia) need frequent monitoring in the 23-hour OU, as they have high hospitalisation rates in the OU.
authors.affiliation: Assistant Professor, Department of Paediatrics, Government Medical College and Hospital , Chandigarh, India .
authors.forename: Vidushi
authors.initials: V
authors.lastname: Mahajan
authors.forename: Sumant
authors.initials: S
authors.lastname: Arora
authors.forename: Tarundeep
authors.initials: T
authors.lastname: Kaur
authors.forename: Sorab
authors.initials: S
authors.lastname: Gupta
authors.forename: Vishal
authors.initials: V
authors.lastname: Guglani
keywords: 23-hour observation unit; India; Paediatric; Triage; Unexpected hospitalisation