589 - Patient and System-Related Factors Predictive of Pediatric Observation Unit Outcomes among Children and Adolescents in Psychiatric Distress

Poster Number: 589
Publication Number: 589.2179

Background: There is increasing reliance on pediatric emergency departments (PED) for psychiatric care. PEDs seek to minimize length of stay (LOS), relieving unnecessary burden on already-crowded PEDs, decreasing costs, and improving patient experience. There are limited studies describing the impact of pediatric observation units (POU) to address this problem. In our urban, academic, community hospital, children presenting to the PED with psychiatric complaints requiring inpatient hospitalization are initially cared for in a POU.

Objective: To identify factors predictive of LOS and disposition of patients in acute psychiatric distress admitted to the POU.

Design/Methods: This study utilized a retrospective cohort design. Inclusion criteria were age <= 18, admitted to POU with an initial decision to admit to an inpatient psychiatric unit from January-December 2022. Charts were reviewed and patient demographics, PED and POU course, and disposition were collected. Multivariate analysis was conducted with log transformed LOS data and variables for sex, age range, payor status, race, chief complaint, arrival mode, and arrival time.

Results: 88 patients met inclusion criteria, and patient characteristics and treatment courses are included in Table 1. 47% of children were discharged from the POU, avoiding inpatient psychiatric admission. A chief complaint of suicidal ideation was associated with completed admission (OR=3.2, 95% CI=1.3-7.7). Linear regression analyses showed predictive factors for longer PED LOS include male sex (beta=-0.29, p=0.01) when adjusting for age range, payor status, race, chief complaint, arrival mode, and arrival time. Predictive factors for longer POU LOS include SI (beta=-0.394, p= < 0.001), White race (beta=-0.23, p=0.02), EMS arrival (beta=-0.21, p=0.04) when adjusting for sex, age range, payor status, and arrival time.

Conclusion(s): Nearly half of youth treated in POU avoided inpatient admission. Patients presenting with SI were more likely to have completed admission. Predictive factors for longer PED LOS included male sex and longer POU LOS included SI, White racial identity, and EMS arrival. POUs may be able to address patient and system needs amidst rising rates of youth psychiatric distress.