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. PURPOSE: To systematically review the literature and evaluate the structure and function of pediatric OUs in the United States. DATA SOURCES: 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. STUDY SELECTION: English language peer‐reviewed publications on pediatric OU care in the United States. DATA EXTRACTION: Two authors independently determined study eligibility. Studies were graded using a 5‐level quality assessment tool. Data were extracted using a standardized form. DATA SYNTHESIS: 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. Journal of Hospital Medicine 2010;5:172–182. © 2010 Society of Hospital Medicine.

Objective Sinus surgery is one of the most frequently performed surgical operations. The objective was to determine if rates of surgery have changed over the last 10 years. Study Design Secondary data analysis of the State Ambulatory Surgery Database of Florida. Methods We calculated population adjusted rates of ambulatory sinus surgery for all adults, 2000–2009. Result There was a substantial decrease in the proportion of patients who had surgery in a hospital setting and a substantial increase in patients who had surgery with image guidance. Population-adjusted rates of sinus surgery increased over the study period, from a mean of 104 cases per 100,000 population in 2000 to 129 per 100,000 in 2009 (p<0.001). Procedure rates also increased, from a mean of 226 per 100,000 in 2000 to 316 per 100,000 in 2009 (p<0.001). Rates of frontal sinus procedures more than doubled, and rates of cases in which all 4 sinuses were treated tripled during the same time period. A greater number of sinus procedures was associated with use of image guidance, and high annual surgical case volume. The strongest predictor was the individual surgeon. Conclusion Rates of sinus surgery increased over the study period, with more patients undergoing surgery and more procedures per surgical case. The strong association of procedural patterns with specific surgeons in sinusitis care highlights the importance of future investigations to examine training, technological, and reimbursement factors that may influence surgeons’ clinical decision-making for this common condition.

BACKGROUNDIn April 2005 the Centers for Medicare and Medicaid Services launched “Hospital Compare,” the first government‐sponsored hospital quality scorecard. We compared the ranking of U.S. News and World Report's “Best Hospitals” with Hospital Compare performance ratings.METHODSWe examined Hospital Compare scores for core measures related to care for acute myocardial infarction (AMI), congestive heart failure (CHF), and community‐acquired pneumonia (CAP). We calculated composite scores for the disease‐specific sets of core measures and a composite combined score for the 14 core measures (across 3 diseases) and determined national score quartile cut points for each set. We then characterized the quartile distribution of Hospital Compare scores for the Best Hospitals for care of cardiac conditions and respiratory disorders in each year, as well as for the Best Hospital “Honor Roll” institutions.RESULTSAMI scores were available for 2165 hospitals, CHF scores for 3130, and CAP scores for 3462. In both 2004 and 2005, fewer than 50% of the Best Hospitals for cardiac care rated in the top quartile of Hospital Compare scores for AMI and CHF. Among the Best Hospitals for care of respiratory disorders, fewer than 15% scored in the top Hospital Compare quartile for CAP. Among Honor Roll institutions, only 5 (of 14 hospitals in 2004; of 16 in 2005) ranked in the top quartile for the combined core measure score.CONCLUSIONSHospital Compare scores are frequently discordant with Best Hospital rankings, which is likely attributable to the markedly different methods each rating approach employs. Such discordance between major quality rating systems paints a conflicting picture of institutional performance for the public to interpret. Journal of Hospital Medicine 2007;2:128–134. © 2007 Society of Hospital Medicine.

Pediatric patients diagnosed with a psychiatric disorder, specifically mood or anxiety disorders, have longer LOS for VOC. These findings suggest that future interventions aimed at managing VOC may need to consider adjunctive psychiatric assessment and intervention.