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.

To determine if 3 objective criteria – pulse oximetry, respiratory syncytial virus (RSV) testing, and age – could be used to predict which children hospitalized with bronchiolitis will have brief (<36 hour) hospitalizations and therefore be potential candidates for admission to short-stay observation units.

This was a retrospective medical record review of medically uncomplicated children 3 to 24 months of age with emergency department and hospital discharge diagnoses consistent with bronchiolitis who were admitted to a general pediatric ward in our university-based, tertiary care hospital between Jan. 1, 1992, and Nov. 12, 2002. Multiple logistic regression was used to assess the predictor variables.

Our study consisted of 225 patients (45% female) with a median age of 7 months (interquartile range [IQR], 4–11 mo; range, 3–22 mo). Median pulse oximetry value was 94% (IQR 91%–96%; range 76%–100%), and 71% of the patients tested positive for RSV. Thirty children (13%) had brief hospitalizations <36 hours, and the median hospital length of stay for the entire study group was 70 hours (IQR 46–108 h; range 6–428 h). None of the 3 predictor variables were independently associated with brief hospitalization.

Pulse oximetry, RSV testing and age do not predict which children will have brief hospitalizations and are appropriate candidates for admission to short-stay observation units.