Shanley Leticia A, Hronek Carla, Hall Matthew, Alpern Elizabeth R, Fieldston Evan S, Hain Paul D, Shah Samir S, Macy Michelle L
Department of Pediatrics, Children's Medical Center of Dallas, University of Texas Southwestern Medical Center, Dallas, Tex.
Children's Hospital Association, Overland Park, Kans.
Acad Pediatr. 2015 Sep-Oct;15(5):518-25. doi: 10.1016/j.acap.2014.12.005.
Observation unit (OU) use has been promoted recently to decrease resource utilization and costs for select patients, but little is known about the operations of pediatric OUs. This study aimed to characterize the infrastructure and function of OUs within freestanding children's hospitals and to compare characteristics between hospitals with and without OUs.
All 43 freestanding children's hospitals that submit data to the Pediatric Health Information System were contacted in 2013 to identify OUs that admitted unscheduled patients from their emergency department (ED) in 2011. Semistructured interviews were conducted with representatives at hospitals with these OUs. Characteristics of hospitals with and without OUs were compared.
Fourteen (33%) of 43 hospitals had an OU during 2011. Hospitals with OUs had more beds and more annual ED visits compared to those without OUs. Most OUs (65%) were located in the ED and had <12 beds (65%). Staffing models and patient populations differed between OUs. Nearly 60% were hybrid OUs, providing scheduled services. OUs lacked uniform outcome measures. Themes included: admissions were intuition based, certain patients were not well suited for OUs, OUs had rapid-turnover cultures, and the designation of observation status was arbitrary. Challenges included patient discontent with copayments and payer-driven utilization reviews.
OUs were located in higher volume hospitals and varied by location, size, and staffing. Most functioned as hybrid OUs. OUs based admissions on intuition, had staffing cultures centered on rapid turnover of patient care, lacked consistent outcome measures, and faced challenges regarding utilization review and patient copayments.
近期，观察单元（OU）的使用得到推广，旨在降低特定患者的资源利用和成本，但对于儿科观察单元的运作情况知之甚少。本研究旨在描述独立儿童医院中观察单元的基础设施和功能，并比较设有和未设有观察单元的医院之间的特征。
2013年，我们联系了所有向儿科健康信息系统提交数据的43家独立儿童医院，以确定在2011年接收急诊科非预约患者的观察单元。对设有这些观察单元的医院的代表进行了半结构化访谈。比较了设有和未设有观察单元的医院的特征。
43家医院中有14家（33%）在2011年设有观察单元。与未设有观察单元的医院相比，设有观察单元的医院床位更多，年度急诊科就诊人次更多。大多数观察单元（65%）位于急诊科，床位少于12张（65%）。各观察单元的人员配备模式和患者群体有所不同。近60%是混合型观察单元，提供预约服务。观察单元缺乏统一的结局指标。主题包括：入院基于直觉，某些患者不太适合观察单元，观察单元有快速周转的文化氛围，观察状态的指定具有随意性。挑战包括患者对自付费用的不满以及支付方驱动的利用审查。
观察单元位于规模较大的医院，在位置、规模和人员配备方面存在差异。大多数观察单元作为混合型观察单元运作。观察单元基于直觉进行入院安排，人员配备文化以患者护理的快速周转为中心，缺乏一致的结局指标，并且在利用审查和患者自付费用方面面临挑战。
