P3.J185: Caring for Sick Children When & Where They Need It: A Sustainable Community-Based Combined Pediatric Emergency Department and Observation Unit

Background: Over the past fifteen years, there has been a 20% decline of pediatric units, with rural communities experiencing a disproportionate impact. The onset of the pandemic exacerbated this trend, as adult beds and care are more profitable. National media has covered the social and health impacts for children who lack access to adequate acute services. Our community has not been immune.

Objective: With strong community support to maintain acute pediatric service access, a new successful model was born: Combined Pediatric Emergency Department (ED) and Observation Unit (OU).

Our stakeholders engaged around the shared goal: to provide excellent and safe care to children by pediatric providers 24/7; meet short stay patient needs close to home; and optimize fiscal responsibility.

Methods: We transitioned from a 10 bed inpatient pediatric unit covered 24/7 by Pediatric Hospitalists and a Pediatric ED open 12 hr/day staffed by Pediatric Emergency Medicine (PEM) physicians and Advanced Practice Nurses (APNs) to a Combined Pediatric ED and OU of 10 beds located in a secure Pediatric ED pod with any 4 of the beds capable of being used as observation stay. The new model is staffed by Pediatric Hospitalists who treat acute care patients as well as observation patients 24/7 and APNs 12 hr/day during high census times. Eligibility for observation care is determined by defined diagnoses, interventions, anticipated length of stay and bed availability. Disease specific and procedural skills training is provided to the entire medical team. Critical cases are stabilized by the main Emergency Medicine team in collaboration with the pediatric team. A partnership with a tertiary pediatric center provides specialty support and transport.

Results: The percentage of patients seen by a dedicated pediatric provider increased from the traditional model of 72% to 93% within 2 years due to the extended pediatric emergency services hours and enhanced skill development. With this model 37-46% of pediatric patients who required a short hospitalization were able to stay close to home. As expected, this is a decrease from 63-65% of patients admitted in the traditional model. The rate of return to the ED within 72 hr for children seen by pediatric hospitalists vs PEM physicians was not significant: 2.71% vs 2.64% (p>>0.05) and is well within benchmarks of 2-5%.

Conclusion: A combined unit of pediatric emergency with observation care is a feasible alternative model for community hospitals without compromising quality of care. It keeps patients close to home and their support system when their child requires a short stay in the hospital.