{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T11:01:32Z","timestamp":1788778892741,"version":"build-2803163510"},"reference-count":35,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,11,1]]},"abstract":"<jats:sec><jats:title>BACKGROUND AND OBJECTIVES:<\/jats:title><jats:p>Length of stay (LOS) is a common benchmarking measure for hospital resource use and quality. Observation status (OBS) is considered an outpatient service despite the use of the same facilities as inpatient status (IP) in most children\u2019s hospitals, and LOS calculations often exclude OBS stays. Variability in the use of OBS by hospitals may significantly impact calculated LOS. We sought to determine the impact of including OBS in calculating LOS across children\u2019s hospitals.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS:<\/jats:title><jats:p>Retrospective cohort study of hospitalized children (age &amp;lt;19 years) in 2017 from the Pediatric Health Information System (Children\u2019s Hospital Association, Lenexa, KS). Normal newborns, transfers, deaths, and hospitals not reporting LOS in hours were excluded. Risk-adjusted geometric mean length of stay (RA-LOS) for IP-only and IP plus OBS was calculated and each hospital was ranked by quintile.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p>In 2017, 45 hospitals and 625\u2009032 hospitalizations met inclusion criteria (IP = 410\u2009731 [65.7%], OBS = 214\u2009301 [34.3%]). Across hospitals, OBS represented 0.0% to 60.3% of total discharges. The RA-LOS (SD) in hours for IP and IP plus OBS was 75.2 (2.6) and 54.3 (2.7), respectively (P &amp;lt; .001). For hospitals reporting OBS, the addition of OBS to IP RA-LOS calculations resulted in a decrease in RA-LOS compared with IP encounters alone. Three-fourths of hospitals changed \u22651 quintile in LOS ranking with the inclusion of OBS.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS:<\/jats:title><jats:p>Children\u2019s hospitals exhibit significant variability in the assignment of OBS to hospitalized patients and inclusion of OBS significantly impacts RA-LOS calculations. Careful consideration should be given to the inclusion of OBS when determining RA-LOS for benchmarking, quality and resource use measurements.<\/jats:p><\/jats:sec>","DOI":"10.1542\/peds.2020-0120","type":"journal-article","created":{"date-parts":[[2020,10,6]],"date-time":"2020-10-06T12:35:17Z","timestamp":1601987717000},"source":"Crossref","is-referenced-by-count":16,"title":["Observation Encounters and Length of Stay Benchmarking in Children\u2019s Hospitals"],"prefix":"10.1542","volume":"146","author":[{"given":"James C.","family":"Gay","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matt","family":"Hall","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital Association, Lenexa, Kansas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rustin","family":"Morse","sequence":"additional","affiliation":[{"name":"Nationwide Children\u2019s Hospital, Columbus, Ohio;"},{"name":"Department of Pediatrics, The Ohio State University, Columbus, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan S.","family":"Fieldston","sequence":"additional","affiliation":[{"name":"Division of General Pediatrics, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennyslvania;"},{"name":"Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Synhorst","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children\u2019s Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle L.","family":"Macy","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Ann and Robert H. 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