title: Observation-status patients in children's hospitals with and without dedicated observation units in 2011.
abstract: BACKGROUND
  Pediatric observation units (OUs) have demonstrated reductions in lengths of stay (LOS) and costs of care. Hospital-level outcomes across all observation-status stays have not been evaluated in relation to the presence of a dedicated OU in the hospital.
  
  
  OBJECTIVE
  To compare observation-status stay outcomes in hospitals with and without a dedicated OU.
  
  
  METHODS
  Cross-sectional analysis of hospital administrative data.
  
  
  METHODS
  Observation-status stay outcomes were compared in hospitals with and without a dedicated OU across 4 categories: (1) LOS, (2) standardized costs, (3) conversion to inpatient status, and (4) return care.
  
  
  METHODS
  Observation-status stays in 31 free-standing children's hospitals contributing observation patient data to the Pediatric Health Information System database, 2011.
  
  
  RESULTS
  Fifty-one percent of the 136,239 observation-status stays in 2011 occurred in 14 hospitals with a dedicated OU; the remainder were in 17 hospitals without. The percentage of observation-status same-day discharges was higher in hospitals with a dedicated OU compared with hospitals without (23.8 vs 22.1, P < 0.001), but risk-adjusted LOS in hours and total standardized costs were similar. Conversion to inpatient status was higher in hospitals with a dedicated OU (11.06%) compared with hospitals without (9.63%, P < 0.01). Adjusted odds of return visits and readmissions were comparable.
  
  
  CONCLUSIONS
  The presence of a dedicated OU appears to have an influence on same-day and morning discharges across all observation-status stays without impacting other hospital-level outcomes. Inclusion of location of care (eg, dedicated OU, inpatient unit, emergency department) in hospital administrative datasets would allow for more meaningful comparisons of models of hospital care.
authors.affiliation: Departments of Emergency Medicine and Pediatrics, Child Health Evaluation and Research Unit, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Macy
authors.affiliation: Children's Hospital Association, Overland Park, Kansas.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hall
authors.affiliation: Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Alpern
authors.affiliation: Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Evan S
authors.initials: ES
authors.lastname: Fieldston
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Leticia A
authors.initials: LA
authors.lastname: Shanley
authors.forename: Carla
authors.initials: C
authors.lastname: Hronek
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Hain
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital and Medical Center, University of Cincinnati School of Medicine, Cincinnati, Ohio.
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D005260:Female; D005377:Financial Management, Hospital / Q000379:methods; D006751:Hospital Information Systems / Q000191:economics / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000191:economics* / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D019370:Observation / Q000379:methods*; D055815:Young Adult