Pediatric length of stay guidelines and routine practice: the case of Milliman and Robertson

Guidelines for inpatient length of stay (LOS) have been developed by Milliman and Robertson (M&R) and are widely applied by health plans. This study was designed to compare LOS for several pediatric conditions with the M&R LOS criteria using recent data and to determine if concordance of actual practice with M&R LOS criteria varied between children and adults.

Administrative data from Pennsylvania hospitals from 1996 through 1998 were used to examine LOS for hospital discharges for 12 selected diagnoses for which M&R published guidelines for children and adults.

Discharge data for all patients discharged from public and private hospitals in Pennsylvania for which 1 of 12 selected diagnoses were examined.

Length of stay.

In Pennsylvania hospitals from 1996 through 1998, pediatric LOS was divergent for all conditions examined, although not to the extent found in a previous study examining data from New York State. Of note, median LOS for some conditions was shorter than M&R LOS criteria. The percentage of pediatric hospital discharges that exceeded the M&R LOS criteria ranged from 25% for pneumonia to 84% for meningitis. Adult hospital discharges exceeded M&R LOS criteria to a greater extent than did pediatric discharges for all conditions except for sickle cell crisis and meningitis.

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.