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[Is it necessary to hospitalize so many children for so many days? Unnecessary pediatric hospitalization]
D Oterino de la Fuente1, A Martínez Martínez, I González Fouces
1Instituto de Investigación en Servicios de Salud.
Insights
Nearly half of all pediatric hospital stays were unnecessary, often due to hospital organization and practice styles rather than medical need. Improving care coordination is crucial for reducing avoidable hospitalizations in children.
Area of Science:
- Pediatric hospital medicine
- Healthcare quality improvement
- Health services research
Background:
- Childhood hospital admissions are increasing, yet evidence suggests many are avoidable or could be shortened.
- There is a need to assess the appropriateness of pediatric hospitalizations to optimize resource allocation and patient care.
Purpose of the Study:
- To determine the proportion of unnecessary pediatric hospital stays.
- To identify the primary reasons contributing to unnecessary hospitalizations in children.
Main Methods:
- A random sample of 388 hospital stays for 151 children (6 months to 14 years) was reviewed.
- The Pediatric Appropriateness Evaluation Protocol (PAEP) was utilized to assess the necessity of each hospital stay.
- Admissions were analyzed based on age group and length of stay, with a focus on programmed and first-time admissions.
Main Results:
- Over 48% of pediatric hospital stays were deemed unnecessary.
- Unnecessary stays were significantly linked to longer durations (over 9 days), programmed admissions (93.5%), and initial hospitalizations (59.9%).
- Hospital organization and physician practices contributed to 74.1% of unnecessary stays, while family circumstances accounted for 21.7%.
Conclusions:
- A substantial percentage of pediatric hospitalizations are unnecessary, highlighting concerns with current admission criteria and discharge planning.
- Addressing hospital organization, physician practices, and improving inter-service coordination is essential for reducing avoidable pediatric hospital stays.
- Enhanced collaboration between hospitals, central services, primary care, and social services is recommended to improve efficiency and appropriateness of pediatric care.
Objective:
A tendency exists towards an increase in hospital admissions of children whereas evidence shows that some of the admissions could have been avoided or the length of stays reduced. The aim of this study was to identify the proportion of unnecessary pediatric stays and the motive behind them.
Patients And Methods:
Three hundred eighty-eight hospital stays of 151 children between 6 months and 14 years of age which were discharged by the local pediatric hospital service have been reviewed. Patients and stays were selected at random. Admissions were stratified by age group and stays by episode length. The Pediatric Appropriateness Evaluation Protocol (PAEP) was used to evaluate the necessity of the hospital stay.
Results:
Of the admissions, 27.8% (42/151) were evaluated as unnecessary, as were 48.7% (189/388) of the hospital stays. Long stays (except for hospitalizations longer than 9 days), programmed admissions (93.5%), first admissions to a hospital (59.9%) and admissions evaluated as unnecessary (80.6%) were significantly associated with unnecessary stays. Hospital organization and doctors' style of practice accounted for 74.1% of the unnecessary stays and children familiar circumstances for 21.7%.
Conclusions:
The high proportion of unnecessary stays and the motives, which explained them, justify the great concern about the criteria for the hospitalization of children and early discharge planning. To improve coordination among hospitals, central services, primary health care services and social services is probably required.
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