Pediatric Length of Stay Guidelines and Routine Practice

Abstract

The M&R LOS criteria were divergent from routine practice for both children and adults. Greater divergence of adult discharges illustrates the need to consider comorbid conditions when implementing these guidelines. Thus, patient care may suffer if guidelines are implemented in an uninformed way. These findings emphasize the importance of using the best possible science when producing guidelines such as these.

Paediatric short stay unit in a community hospital: Effective, efficient and popular

“…The SSU was also efficient, with a high proportion of children staying for comparable or shorter time periods than would occur in other models of care. 16,17 We suggest that the presence of -and ownership bysenior emergency staff facilitated evening and nighttime discharge, hence further improving efficiencies. The unit proved to be popular, as the vast majority of service users indicated positive experiences.…”

“…Anecdotally, we found that most families chose to continue to remain in the SSU rather than be transferred. Although some appendicectomy patients stayed longer than 48 h, this time frame is not out of keeping with general standards and averages of length of stay for this operation, 16,18 and thus the unit has decided to continue to care for these patients. We were much more particular to transfer patients when there was diagnostic uncertainty, when disease was clinically severe (or potential for deterioration was high) or when tertiary services were required.…”

Inpatient Observation After Transition From Intravenous to Oral Antibiotics

“…We also excluded children hospitalized $7 days because they could have completed their antibiotic course while admitted; this also functioned to minimize the possibility of including children with a complicated infection. 1,19 Patients who died during the hospitalization and patients with missing ICU flag data were not included in our analysis.…”

Observation Status—A Name at What Cost?

“…However, resource utilization under both settings appears to be comparable for pediatric patients. 6 Physicians are generally unaware of the specifi c criteria used to classify patients as observation or inpatient (InterQual's 2013 review criteria is 568 pages in length), and these criteria do not play a role in their clinical decision-making. Is it therefore rational that reimbursement for a service be driven by the administrative status documented on a patient's record when the resource utilization is comparable?…”