149 - Development of a Pediatric Hospitalist-Staffed Observation Unit in an Emergency Department: A Tertiary Care Children’s Hospital Experience

Poster Number: 149
Publication Number: 149.1328

Background: Patients seen in the Emergency Department (ED) frequently require services beyond the initial ED care to determine the need for inpatient admission. These distinct and reimbursable services include further diagnostic and management evaluations. Successfully caring for ED observation patients requires dedicated ED space, staff and resources commitment, and availability of services for patient care and disposition. There is limited literature describing the development process of an Observation Unit (OU) in an Emergency Department staffed by Pediatric Hospitalists.

Objective: To describe the development of an Observation Unit (OU) in the ED staffed by Pediatric Hospital Medicine (PHM) faculty using evidenced-based, medical necessity screening tools with the goal of caring for patients meeting observation status in an OU and improving inpatient capacity.

Design/Methods: OU admission criteria were developed by stakeholders using past PHM discharge diagnoses data under observation status and application of medical necessity screening guidelines. A 12-bed OU space was identified in the ED and “best practices” for admission, monitoring, staffing, services and resource needs, and disposition were developed. Patients who met inpatient criteria were transferred to an inpatient unit. Education was provided to stakeholders and weekly huddles reviewed missed patient placement in OU.

Results: Over the study period (April- September 2023), 636 patients met OU admission criteria. The average daily census ranged from 4-6 patients with an age range of 2 day to 17 years old children. With triage experience, the percentage of patients transferred to an inpatient bed reduced from 12% to 5% in September 2023. The average length of stay was 38 hours (range 21-47 hours). The most common discharge diagnoses were dehydration, acute bronchiolitis without hypoxia, neonatal hyperbilirubinemia, and asthma exacerbation. The OU was staffed 24/7 by PHM faculty and nursing ratios were at 4:1. All required interdisciplinary services were available 24/7 with no reported serious safety events. To maximize OU bed usage, criteria were expanded to include orthopedic and general surgery patients using past local data.

Conclusion(s): Developing best practices for managing patients in an OU through stakeholder collaboration led to a successful OU in the ED area. Gaining triage experience, the inpatient transfer rate was reduced to 5%. This model may help hospitals care for observation patients in ED space while effectively utilizing inpatient capacity.