[The use of resources. Unnecessary stays in pediatric surgical services]

Area of Science:

• Pediatric Surgery
• Healthcare Management
• Health Services Research

Background:

• Widespread consensus exists regarding the inadequate use of hospital resources, where patients receive services lacking significant benefit or could be managed more cost-effectively.
• Inefficient resource utilization in healthcare settings contributes to increased costs and potentially suboptimal patient outcomes.

Purpose of the Study:

• To quantify the percentage of inappropriate hospital stays within a pediatric surgery service.
• To identify the primary causes contributing to these unnecessary hospitalizations in pediatric patients.

Main Methods:

• A concurrent study was conducted involving pediatric patients admitted for at least 24 hours for surgery, observation, or study.
• The pediatric version of the Appropriateness Evaluation Protocol was utilized to assess the appropriateness of hospital stays by reviewing medical records.
• Data collected included the determination of stay appropriateness and the identification of causative factors.

Main Results:

• Out of 1,001 total stays for 279 patients, 373 (37.3%) were deemed unnecessary.
• Conditions with the highest rates of inappropriate stays included cryptorchidism (97.3%), hernia (88.9%), hypertrophic pyloric stenosis (50%), and soft tissue surgery (43.1%).
• The primary responsibility for unnecessary stays lay with the hospital-service-surgeon (68.2%), followed by environmental/family factors (22.6%) and lack of alternative resources (9.2%).

Conclusions:

• A substantial proportion of daily hospital stays in pediatric surgery could be avoided.
• Systematic identification of unnecessary hospital stays is crucial for pinpointing areas for targeted quality improvement initiatives.
• Addressing the identified causes of inappropriate utilization can lead to more efficient healthcare delivery and better resource management in pediatric surgery.