191 Outcomes and Cost: A Retrospective Analysis of Admissions to a Pediatric Observation Unit Versus Inpatient Hospitalization

Abstract

Many pediatric patients requiring inpatient admission are otherwise healthy children with self-limited illnesses and discharged within 48 hours, making them ideal candidates for care in a pediatric observation unit (POU). Respiratory illnesses remain a leading cause for hospital admission and there have been recent changes in the management of these conditions. Differences in patient outcomes for admission to a POU versus a pediatric inpatient unit (PIU) have not been thoroughly evaluated. We determine differences in length of stay (LOS) and cost between children being admitted to a pediatric observation unit and a traditional inpatient unit. In January 2017, pediatric inpatient beds were moved from an urban, academic, community hospital to an off-site tertiary academic children’s hospital. Subsequently, a pediatric observation unit (POU) was opened adjacent to the pediatric emergency department. In this retrospective observational cohort study, eligible subjects included children 0-18 years old who met criteria for admission to the POU. As the units were not concurrently open, data was collected from January through June 2016 for children admitted to the PIU and January through June in 2017 for children admitted to the POU to control for seasonal variation in admissions. Information regarding the current illness, past medical history, treatment in the PED, and course in the POU or PIU were collected. The hospital LOS was analyzed as the primary outcome. Changes in level of care and composite hospital costs and denials data were collected as secondary outcomes. Data from 116 admissions have been analyzed, 65 admitted to POU and 51 to PIU. Group characteristics are listed in Table 1. The mean LOS was 25.0 hours, 95% CI [21.5, 28.5] for the POU group and 64.5 hours, 95% CI [54.6, 74.5] for the PIU group (p<0.01). Three patients in the POU group were subsequently transferred to the PIU, none were transferred from the POU to the intensive care unit (ICU), and 1 patient was transferred from the PIU to the ICU. The physician staffing cost to patient ratio was $2,293 for the PIU and $2,403 for the POU. The payer denial rate for PIU and POU was 10.0% and 0.6%, respectively, for visits less than 48 hours. Children admitted to the POU appeared to have a significantly shorter LOS compared to those admitted to a PIU without more complications. Pediatric observation units may provide the means toward cost-efficient, patient-centered care for children with illnesses requiring brief hospitalizations.Tabled 1Patient characteristicsPOUPIUTotal Enrolled6551Male (%)31 (47.7)26 (51.0)Age in years (SD)6.2 (5.1)7.2 (5.7)Respiratory Illnesses (%)43 (66.2)31 (60.8)Illness days (SD)3.5 (2.6)2.6 (2.6)Previous Hospitalizations (SD)1.4 (1.2)0.3 (1.1) Open table in a new tab