The Short Stay Unit
from Practice Update, Fall 2004
On January 5, 2004, the Short Stay Unit (SSU) opened at The Children’s Hospital. This new inpatient unit is designed to provide efficient care for otherwise healthy children who have an acute illness requiring brief hospitalization. The SSU enables The Children’s Hospital to integrate the community hospital approach for treating acute illness within an academic tertiary care teaching hospital. In addition, the unit provides an additional opportunity for The Children’s Hospital house staff to manage common pediatric illnesses efficiently and safely. This unit also opens up more time for the ward service to focus on more complicated patients.
Length of Stay (LOS) Comparisons in Days
LOS comparison are based on all inpatients
discharged during the first quarter of 2002-2003-2004
with a principal diagnosis of ACUTE BRONCHIOLITIS,
ACUTE BRONCHIOLITIS/RESP, ACUTE
BRONCHIOLITIS/OTHER, RESP SYNCYT VIRAL
PNEUM and VIRAL PNEUMONIA NOS
Located on the fourth floor, the SSU includes 12 beds and is under the medical direction of two Emergency Medicine attendings, Lalit Bajaj, MD, and Genie Roosevelt, MD. The unit is staffed by either an Emergency Medicine attending or a General Pediatric attending for one week blocks at a time, while Kaiser and private pediatricians may attend on their patients as well. Matt Dorighi, MD, of Cherry Creek Pediatrics commented, “The physicians at Cherry Creek Pediatrics are very pleased with the efficiency of care that the SSU provided over the wintertime. Our patients were very pleased with their experience as well.”
The medical team structure for the unit also includes a dedicated nursing staff, respiratory therapists and a pediatric resident available from 7 a.m. to midnight, after midnight the ward resident is also available.
While the admission criteria for The Children’s Hospital have not changed, several of the diagnoses previously treated on the wards are now admitted to the SSU. Eligible diagnoses to the SSU include bronchiolitis, asthma, uncomplicated pneumonia (bacterial or viral), croup, uncomplicated cellulites, diarrhea, vomiting, dehydration, UTI/pyeonephritis, R/O SBI (without evidence of meningitis by exam or LP) and accidental ingestions. In the first three months the SSU was open, more than 500 patients were initially identified as potential admissions and 437 of these patients were admitted, with the primary diagnosis being bronchiolitis.
When patients admitted to the SSU were compared with patients admitted to the regular ward for similar diagnosis for the same time period of the previous year, there was a marked decrease in length of stay, chest x-ray use and ancillary testing. For respiratory diagnoses the median length of stay (LOS) from arrival at inpatient bed to hospital discharge differed by 19 hours. SSU patient’s averaged a LOS of 28 hours while the average LOS for the non SSU patients was 47 hours. (Comparisons were limited as non SSU patients may represent patients with higher acuity of illness and and/or co-morbid conditions.) In addition, significantly more patients were discharged on home oxygen therapy for bronchiolitis from the SSU than the regular wards.
Since the SSU opened, the housestaff have enjoyed their experience on the unit as they were exposed to a variety of attendings and patient management strategies in the care of “bread and butter” pediatric illnesses. The nurses on the SSU reported high job satisfaction as they felt they received respect from physicians on their clinical judgment and were allowed to function more autonomously. In addition, both groups enjoyed being an integral part of the development of a new model of inpatient care. As the SSU heads into its second year of operation, the care team will build on the unit’s strengths and successes and investigate other diagnoses that can benefit from the model.
