System outcomes associated with a pediatric emergency department clinical decision unit

Derin Karacabeyli, Garth D. Meckler, David K. Park, Quynh Doan

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives Our objectives were to describe disposition decisions and emergency department return (EDR) rates following a clinical decision unit (CDU) stay; and to determine changes to short stay (<48 hour) hospitalization rates after CDU implementation.Methods We conducted a retrospective cohort study of pediatric emergency department (PED) visits with a CDU stay from January 1 to December 31, 2015. Health records data were extracted onto standardized online forms, then used to determine disposition and 7-day EDR rates. Two trained investigators blindly reviewed EDR visits to determine if they were related to the index CDU stay. We compared short stay inpatient admission rates (i.e., hospital length of stay <48 hours) in 2013 and 2015, before and after CDU implementation.Results Of 1696 index CDU stays, 1503 (89%) were discharged, and 139 discharged patients (9.2%) had ≥1 clinically-related EDR. Median (IQR) CDU length of stay (LOS) was 4.4 hours (2.7-7.8) and total PED LOS (including CDU) was 7.8 hours (5.4-12.0). Asthma represented 31% of cases. Short stay hospitalization rate decreased from 3.62% in 2013 to 3.23% in 2015 (difference=0.39%; 95% CI=0.15-0.63; p=0.001).Conclusions Most CDU patients were discharged, but 9% had a clinically-related ED revisit. CDU implementation was associated with a small but significant reduction in short stay hospitalization.

Original languageEnglish (US)
Pages (from-to)195-198
Number of pages4
JournalCanadian Journal of Emergency Medicine
Volume21
Issue number2
DOIs
StatePublished - Mar 1 2019
Externally publishedYes

Keywords

  • clinical decision unit
  • hospitalization
  • observation unit
  • pediatric emergency department
  • revisit
  • system outcomes

ASJC Scopus subject areas

  • Emergency Medicine

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