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Reducing inappropriate hospital use on a general pediatric inpatient unit
Sanjay Mahant1, Rishita Peterson, Maggie Campbell
1Department of Pediatrics, Paediatric Outcomes Research Team, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada M5G 1X8. sanjay.mahant@sickkids.ca
Insights
An audit-and-feedback intervention reduced inappropriate hospital days for children without increasing readmissions. This strategy helps optimize pediatric inpatient care by identifying key reasons for non-qualified hospital stays.
Area of Science:
- Pediatric Hospital Medicine
- Healthcare Quality Improvement
- Utilization Review
Background:
- High rates of inappropriate hospital use in children are a documented concern.
- Optimizing pediatric inpatient resource utilization is crucial for effective healthcare delivery.
Purpose of the Study:
- To assess the effectiveness of an audit-and-feedback intervention in reducing inappropriate hospital days on a general pediatric inpatient unit.
Main Methods:
- A prospective observational study with a before-and-after design was conducted.
- A nurse utilized a utilization review tool to classify hospital days as qualified or nonqualified.
- The intervention involved weekly feedback to attending physicians and summary report dissemination.
Main Results:
- The intervention group showed a significantly lower risk of inappropriate hospital days (33% nonqualified) compared to the preintervention group (47% nonqualified).
- Reasons for nonqualified days like 'finishing intravenous antibiotics' and 'awaiting tests' decreased, while 'lack of an alternate level of care' increased.
- The 48-hour readmission rate was 1.0% during the intervention phase versus 1.6% in the preintervention phase.
Conclusions:
- Audit-and-feedback interventions directed at attending physicians can effectively lower inappropriate pediatric hospital days.
- This intervention strategy did not lead to an increase in patient readmission rates.
- The utilization review tool successfully identified key processes contributing to inappropriate hospital utilization.
Objective:
Studies have documented high rates of inappropriate hospital use in children. We assessed the effectiveness of an audit-and-feedback intervention at reducing inappropriate hospital days on a general pediatric inpatient unit.
Methods:
A prospective observational study, using a before-and-after design, was conducted at a tertiary care pediatric hospital in Canada between March 2005 and August 2006. The appropriateness of all hospital days for all admissions was evaluated by a nurse trained in using a utilization review tool. This tool classifies hospital days as "qualified" or "nonqualified" on the basis of the nature of the inpatient services that are used. Reasons for nonqualified days were classified. The intervention consisted of (1) weekly feedback to attending physicians of which patients were nonqualified and (2) dissemination of summary reports to attending physicians. Comparisons were made between the preintervention (March 2005 to August 2005) and intervention (March 2006 to August 2006) phases.
Results:
The intervention was associated with a significantly lower risk of inappropriate hospital days. Of the 7246 hospital days in the 6-month intervention phase, 2413 (33%) were nonqualified versus 3859 (47%) of 8228 hospital days in the 6-month preintervention phase. A total of 7.35 hospital days would have to be reviewed, combined with weekly feedback, to prevent 1 nonqualified hospital day. The 48-hour readmission rate in the intervention phase and preintervention phase was 1.0% and 1.6%, respectively. The proportion of nonqualified days to total hospital days that were attributable to "finishing intravenous antibiotics," "awaiting tests," "providing nutrition," "observation only," "tapering treatment," and "teaching" decreased significantly, whereas the "lack of an alternate level of care" increased significantly.
Conclusions:
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.
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