Observation unit helps improve outcomes and satisfaction


A program at a hospital in New York City looked at how adding a pediatric observation unit to the existing pediatric emergency department helped improve patient outcomes and patient satisfaction.

Mount Sinai Beth Israel in New York, New York, started a pediatric observation unit (POU) to run adjacent to their pediatric emergency department (PED). A report examining the impact of the POU on length of stay, conversion rates, and patient satisfaction was published in BMJ Open Quality.1

The staff in the hospital’s PED designed staffing models to provide pediatric services in both the PED and the POU. They also developed workflow, admission criteria, and transfer guidelines. Data on unit throughput, patient outcomes, and satisfaction were collected and analyzed.

Over the course of 2 years, the PED had 24,038 patient visits and admission was required for 1215 patients. In this subset, 777 of the children were admitted into the POU. Inpatient hospitalization was required for 119 of the patients. In 2017, the average length of stay was 25.7 hours and 26.5 hours in 2018. In the studied period, 10 patients came back to the PED within 72 hours of discharge from the POU and 4 of those children were readmitted. Over a period of 1 year, the patient satisfaction score for “likelihood to recommend” went from the 36th to the 92nd percentile rank.

Lessons learned

When discussing the lessons learned from the experience of implementing the POU, the staff said that developing the staffing model that serviced children in adjacent units with differing care goals proved to be a challenge. Switching between the acute care demands of the PED and the ongoing management in the POU also was initially difficulty for providers. Cross-training and further delineation of care responsibilities helped alleviate these problems.

There were limitations to the project’s report, which included no available cost analysis. Using patient callbacks within 72 hours of discharge could be a limitation for measuring unexpected return to care because the department was unable to tell if those who didn't respond or were lost to follow-up ended up seeking care elsewhere.

The report’s authors concluded that implementing a POU alongside the PED allowed for patients and families to have access to specialty care when presenting to the hospital. As a majority of patients who required admission were able to be managed in the POU, the burden for inpatient beds in the pediatric unit also decreased. The researchers believe that as the POU’s staff becomes more experienced, further improvements will occur.


1. Lim CAE, Oh J, Eiting E, Coughlin C, Calderon Y, Barnett B. Development of a combined paediatric emergency department and observation unit. BMJ Open Quality 2020;9:e000688.

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