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

Abstract

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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