Impact of an Observation Unit and an Emergency Department-Admitted Patient Transfer Mandate in Decreasing Overcrowding in a Pediatric Emergency Department

Hung, Geoffrey R.; Kissoon, Niranjan

doi:10.1097/pec.0b013e31819a7e20

Cited by 19 publications

(12 citation statements)

References 5 publications

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“…Variations in reimbursement may limit hospital efforts to refine models of observation care for children. Designated OUs have been suggested as a method for improving ED patient flow, 26 increasing inpatient capacity, 27 and reducing costs of care. 28 Standardization of observation status criteria and consistent reimbursement for observation services may be necessary for hospitals to develop operationally and physically distinct OUs, which may be essential to achieving the proposed benefits of observation medicine on costs of care, patient flow, and hospital capacity.…”

Section: Discussionmentioning

confidence: 99%

Differences in designations of observation care in US freestanding children's hospitals: Are they virtual or real?

Macy¹,

Hall²,

Shah³

et al. 2011

Journal of Hospital Medicine

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OBJECTIVE:To characterize practices related to observation care and to examine the current models of pediatric observation medicine in US children's hospitals.DESIGN:We utilized 2 web‐based surveys to examine observation care in the 42 hospitals participating in the Pediatric Health Information System database. We obtained information regarding the designation of observation status, including the criteria used to admit patients into observation. From hospitals reporting the use of observation status, we requested specific details relating to the structures of observation care and the processes of care for observation patients following emergency department treatment.RESULTS:A total of 37 hospitals responded to Survey 1, and 20 hospitals responded to Survey 2. Designated observation units were present in only 12 of 31 (39%) hospitals that report observation patient data to the Pediatric Health Information System. Observation status was variably defined in terms of duration of treatment and prespecified criteria. Observation periods were limited to <48 hours in 24 of 31 (77%) hospitals. Hospitals reported that various standards were used by different payers to determine observation status reimbursement. Observation care was delivered in a variety of settings. Most hospitals indicated that there were no differences in the clinical care delivered to virtual observation status patients when compared with other inpatients.CONCLUSIONS:Observation is a variably applied patient status, defined differently by individual hospitals. Consistency in the designation of patients under observation status among hospitals and payers may be necessary to compare quality outcomes and costs, as well as optimize models of pediatric observation care.Journal of Hospital Medicine 2012;. © 2011 Society of Hospital Medicine.

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Section: Discussionmentioning

confidence: 99%

Differences in designations of observation care in US freestanding children's hospitals: Are they virtual or real?

Macy¹,

Hall²,

Shah³

et al. 2011

Journal of Hospital Medicine

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“…This proposition was supported in the real world by Han et al ,106 who reported no change in ambulance diversion and an increase in ED LOS, when the number of beds in their ED was doubled. Viccelio et al 107 have demonstrated the safety of a protocol allowing patients to be ‘pushed’ into inpatient hallways, but did not study the effect on crowding, while Hung and Kissoon108 (computer modelling) and Quinn et al 109 (real world) demonstrated a small reduction in ED LOS +/− ambulance diversion when patients were transferred directly into inpatient beds without waiting to be reviewed by inpatient teams. The best-studied intervention is the use of holding units, observation units or assessment units to decant patients from the ED.…”

Section: Solutions For Crowdingmentioning

confidence: 99%

Emergency department crowding

Higginson

2012

Emerg Med J

102

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“…Patients in EDs may experience long delays when ED rooms are being used by patients needing ongoing treatment or awaiting an inpatient bed. A computer simulation study at the Children' s Hospital in Vancouver British Columbia 43 revealed that an OU would reduce wait times in the pediatric ED by creating additional capacity and improving patient flow.…”

Section: Effect Of Ous On Inpatient Hospital Utilizationmentioning

confidence: 99%

Pediatric Observation Units

Conners¹,

Melzer²,

Percelay³

et al. 2012

Pediatrics

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Pediatric observation units (OUs) are hospital areas used to provide medical evaluation and/or management for health-related conditions in children, typically for a well-defined, brief period. Pediatric OUs represent an emerging alternative site of care for selected groups of children who historically may have received their treatment in an ambulatory setting, emergency department, or hospital-based inpatient unit. This clinical report provides an overview of pediatric OUs, including the definitions and operating characteristics of different types of OUs, quality considerations and coding for observation services, and the effect of OUs on inpatient hospital utilization.

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Impact of an Observation Unit and an Emergency Department-Admitted Patient Transfer Mandate in Decreasing Overcrowding in a Pediatric Emergency Department

Abstract: Simulation scenario analyses predict that an OU and a transfer mandate would reduce overcapacity in the PED, with more substantial reductions in time to be seen and length of stay for patients of high acuity.

Cited by 19 publications

References 5 publications

Differences in designations of observation care in US freestanding children's hospitals: Are they virtual or real?

Differences in designations of observation care in US freestanding children's hospitals: Are they virtual or real?

Emergency department crowding

Pediatric Observation Units

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