System outcomes associated with a pediatric emergency department clinical decision unit

• Published in: Canadian journal of emergency medicine Vol. 21; no. 2; pp. 195 - 198
• Main Authors: Karacabeyli, Derin, Meckler, Garth D, Park, David K, Doan, Quynh
• Format: Journal Article
• Language: English
• Published: New York, USA Cambridge University Press 01.03.2019; Springer Nature B.V
• Subjects: Anaphylaxis; Asthma; Asthma - epidemiology; British Columbia - epidemiology; Child; Child, Preschool; Childrens health; Cohort analysis; Cohort Studies; Emergency medical care; Emergency Service, Hospital; Emergency services; Female; Gastrointestinal diseases; Hospital Units; Hospitalization; Hospitals; Humans; Length of Stay - statistics & numerical data; Male; Original Research; Patient Readmission - statistics & numerical data; Patients; Pediatrics; Retrospective Studies; Statistical analysis; Workforce planning; British Columbia; British Columbia Canada; United States > US; system outcomes; revisit; observation unit; hospitalization; pediatric emergency department; clinical decision unit
• ISSN: 1481-8035; 1481-8043
• DOI: 10.1017/cem.2018.57

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. 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. 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). 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.