Addition of pediatric observation unit improves care at NYC hospital
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The implementation of a pediatric observation unit, or POU, reduced patient length of stay and conversion rates and increased patient satisfaction at a New York City hospital, according to a study published in BMJ Open Quality.
“Most children require brief hospitalizations for common conditions such as asthma, pneumonia, bronchiolitis, skin infections and dehydration,” Czer Anthoney Enriquez Lim, MD, director of pediatric emergency medicine in the Mount Sinai Health System, told Healio. “In community hospitals without inpatient pediatric units where families may need to be transferred for inpatient care, or children’s hospitals with frequent boarding issues, developing observation services may be a viable option to provide optimal acute and ongoing pediatric care.”
Lim and colleagues implemented a POU adjacent to the pediatric emergency department (PED) at Mount Sinai Beth Israel in New York, with an aim to limit patient length of stay to less than 48 hours and to maintain a 15% or better conversion rate. They collected data from 777 children admitted from January 2017 to December 2018, with 41% of all admissions attributed to respiratory illness.
Length of stay decreased for both years in which the POU was implemented, with an average length of stay of 25.7 hours in 2017 and 26.5 hours in 2018. The conversion rate goal also was met, with the overall conversion rate dropping from 18.7% in the first year to 13.1% in the second year. A patient satisfaction survey conducted during the study showed improved patient opinions as well, with scores regarding respondents’ “likelihood to recommend” improving from the 36th to 92nd percentile.
Aside from the implementation of a POU, Lim stressed that other measures can be taken to improve patient length of stay.
“We have found that engaging parents and caregivers early and partnering with community pediatric practices ensures smooth transitions back home and short follow-up with their pediatricians,” Lim said. “We are also developing programs such as acute hospitalization at home and telehealth that will further impact length of stay.”
Lim noted that POUs have the potential to be implemented in other pediatric emergency care settings.
“Our next steps also include a cost-effectiveness analysis, which can evaluate savings to patients, insurance companies and hospitals as a result of a flexible staff, reduced length of stay and increasing capacity for the Children’s Hospital to have beds for more complex pediatric cases,” Lim said. “Additionally, although there is a trend toward consolidated services in health systems throughout the country, this was a single site experience and we look forward to implementing similar models in other settings.” – by Eamon Dreisbach
Disclosures: The authors report no relevant financial disclosures.
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