Trends and Variation in the Use of Observation Stays at Children's Hospitals

• DOI: 10.12788/jhm.3622
• Publication Date: 2021-07-29T22:00:47Z
• Authors: Yao Tian; Matt Hall; Martha‐Conley E I...; Andrew Hu; Mehul V Raval
• Keywords: Adult; Inpatients; 03 medical and health sciences; 0302 clinical medicine; Databases, Factual; Humans; Length of Stay; Child; Hospitals, Pediatric; Retrospective Studies; 3. Good health

BACKGROUNDObservation status could improve efficiency of healthcare resource use but also might shift financial burdens to patients and hospitals. Although the use of observation stays has increased for adult patient populations, the trends are unknown among hospitalized children.OBJECTIVEThe goal of this study was to describe recent trends in observation stays for pediatric populations at children's hospitals.DESIGN, SETTING, AND PARTICIPANTSBoth observation and inpatient stays for all conditions were retrospectively studied using the Pediatric Health Information System database (2010 to 2019).EXPOSURE, MAIN OUTCOMES, AND MEASURESPatient type was classified as inpatient or observation status. Main outcomes included annual percentage of observation stays, annual percentage of observation stays having prolonged length of stay (>2 days), and growth rates of observation stays for the 20 most common conditions. Risk adjusted hospital‐level use of observation stays was estimated using generalized linear mixed‐effects models.RESULTSThe percentage of observation stays increased from 23.6% in 2010 to 34.3% in 2019 (P < .001), and the percentage of observation stays with prolonged length of stay rose from 1.1% to 4.6% (P < .001). Observation status was expanded among a diverse group of clinical conditions; diabetes mellitus and surgical procedures showed the highest growth rates. Adjusted hospital‐level use ranged from 0% to 67% in 2019, indicating considerable variation among hospitals.CONCLUSIONBased on the increase in observation stays, future studies should explore the appropriateness of observation care related to efficient use of healthcare resources and financial implications for hospitals and patients.