Reducing Inappropriate Hospital Use on a General Pediatric Inpatient Unit

Mahant, Sanjay; Peterson, Rishita; Campbell, Maggie; MacGregor, Daune; Friedman, Jeremy

doi:10.1542/peds.2007-2898

Cited by 15 publications

(13 citation statements)

References 16 publications

(9 reference statements)

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“…The proportion of HTO stays climbed during a period of declining hospital discharges and LOS, suggesting some hospitalizations have been avoided, whereas others have been compressed into shorter treatment periods. Factors that may have contributed to the rise in HTO stays include changes in medical treatment, prospective payment systems,27 utilization review,28,29 care delivered in the ED before admission, the hospitalist movement,30,31 and condition-specific treatment protocols 32…”

Section: Discussionmentioning

confidence: 99%

Trends in High-Turnover Stays Among Children Hospitalized in the United States, 1993–2003

Macy¹,

Stanley²,

Lozon³

et al. 2009

Pediatrics

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OBJECTIVE-Brief hospitalizations for children may constitute an opportunity to provide care in an alternative setting such as an observation unit. The goal of this study was to characterize recent national trends in brief inpatient stays for children in the United States.METHODS-Using the Nationwide Inpatient Sample from 1993-2003, we analyzed hospital discharges among children <18 years of age, excluding births, deaths, and transfers. Hospitalizations with lengths of stay of 0 and 1 night were designated as "high turnover." Serial cross-sectional analyses were conducted to compare the proportion of high-turnover stays across and within years according to patient and hospital-level characteristics. Diagnosis-related groups and hospital charges associated with these observation-length stays were examined. RESULTS-In 2003, there were an estimated 441 363 high-turnover hospitalizations compared with 388 701 in 1993. The proportion of high-turnover stays increased from 24.9% in 1993 to 29.9% in 1999 and has remained ≥30.0% since that time. Diagnosis-related groups for high-turnover stays reflect common pediatric medical and surgical conditions requiring hospitalization, including respiratory illness, gastrointestinal/metabolic disorders, seizure/headache, and appendectomy. Significant increases in the proportion of high-turnover stays during the study period were noted across patient and hospital-level characteristics, including age group, payer, hospital location, teaching status, bed size, and admission source. High-turnover stays contributed $1.3 billion (22%) to aggregate hospital charges in 2003, an increase from $494 million (12%) in 1993. CONCLUSIONS-Consistently since 1999, nearly one third of children hospitalized in the UnitedStates experience a high-turnover stay. These high-turnover cases constitute hospitalizations, that may be eligible for care in an alternative setting. Observation units provide 1 model for an efficient and cost-effective alternative to inpatient care, in which resources and provider interactions with patients and each other are geared toward shorter stays with more timely discharge processes. Observation units have widespread use in adult emergency medicine, demonstrating a strong track record with shorter stays and reduced ward admission rates for common conditions such as chest pain, asthma, and cellulitis. [12][13][14][15][16][17][18] Work from McConnochie et al [19][20][21] in the 1990s indicated that a significant number of pediatric hospitalizations could be cared for in an alternative setting, such as an observation unit. Individual institutions have been successful in using pediatric observation units to decrease LOS, 2,4,9,22 reduce admission rates, 5,10,23 and control costs. 2,9 However, little is known about the potential at the national level for children to receive care in an observation unit setting. KeywordsIn this study, we used the Nationwide Inpatient Sample (NIS) over a period of 1 decade to provide national estimates of the number of US children who experi...

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Section: Discussionmentioning

confidence: 99%

Trends in High-Turnover Stays Among Children Hospitalized in the United States, 1993–2003

Macy¹,

Stanley²,

Lozon³

et al. 2009

Pediatrics

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“…Previous studies have reported children's readmission rates ranging from 0.4% to 7% across durations of 2, 3, 7, 14, 21, 28 and unspecified days 8 9 15. The risk of capturing unrelated admissions could be expected to increase with longer time periods.…”

Section: Introductionmentioning

confidence: 99%

“…A review of patient records in the 1990s found that half of an English hospital's emergency admissions were considered inappropriate by paediatricians,4 and more recently 30% of admissions and 56% of days of hospitalisation were categorised as inappropriate in an Italian hospital 5. Guidelines for triage,6 for specific conditions such as bronchiolitis,7 and for audit and feedback8 have all been proposed to prevent avoidable hospitalisations.…”

Section: Introductionmentioning

confidence: 99%

Readmission in children's emergency care: an analysis of hospital episode statistics

Callery

Kyle

Campbell

et al. 2009

Archives of Disease in Childhood

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“…Health-Related Quality of Life (HRQoL) has been established as an important gauge of patient-based health outcomes and a recommended endpoint in all clinical trials [15]. An understanding of the caregiver’s concerns in the outpatient setting is particularly important given that recent health care cost containment measures have shifted services from inpatient to ambulatory care settings, and thereby increased the burdens placed upon the caregivers of affected children [16, 17]. Existing tools, which measure the generalized HRQoL of caregivers, may lack sensitivity for the detection of the unique concerns associated with caring for children with specific medical conditions [18].…”

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confidence: 99%

Impact of Children’s Feeding/Swallowing Problems: Validation of a New Caregiver Instrument

et al. 2014

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The impact of caring for children with deglutition disorders is poorly understood and tools to measure the unique concerns of these caregivers are lacking. The aims of this investigation were to develop and validate The Feeding/Swallowing Impact Survey (FS-IS) as an instrument designed to measure and improve understanding of caregiver issues. Demographic, economic, and dysphagic data were provided by the primary caregivers of 164 children (median age: 14 months, male: 78, female: 86) presenting for initial outpatient feeding/swallowing evaluations. Caregivers completed the PEDS-QL™ Family Impact Module (PEDS-QL™ FIM) and the FS-IS. A principal component analysis was conducted on the FS-IS to identify appropriate subscales. Concurrent validity was assessed by examining correlations between the FS-IS and PEDS-QL™ FIM. Caring for children with feeding/swallowing problems adversely impacted the Health-Related Quality of Life (HRQoL) of their caregivers. The FS-IS had a strong 3-factor solution to indicate 3 subscales: Daily Activities, Worry, and Feeding Difficulties. All three sub-scales and total score of the FS-IS correlated with PEDS-QL™ FIM. The FS-IS was validated as an instrument that may help clinicians detect specific factors that influence caregiver HRQoL, identify caregivers who might benefit from additional support, and ultimately improve the care of their children with feeding/swallowing disorders.

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Reducing Inappropriate Hospital Use on a General Pediatric Inpatient Unit

Abstract: An audit-and-feedback intervention directed at attending physicians was associated with a lower risk of inappropriate hospital days without an increase in the readmission rate. The utilization review tool also identified processes that impact on inappropriate hospital days.

Cited by 15 publications

References 16 publications

Trends in High-Turnover Stays Among Children Hospitalized in the United States, 1993–2003

Trends in High-Turnover Stays Among Children Hospitalized in the United States, 1993–2003

Readmission in children's emergency care: an analysis of hospital episode statistics

Impact of Children’s Feeding/Swallowing Problems: Validation of a New Caregiver Instrument

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