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Rounding frequency and hospital length of stay for children with respiratory illnesses: a simulation study
Joseph East1, Allison Cator, Emily Burns
1Industrial and Operations Engineering Department, University of Michigan, Ann Arbor, Michigan; Health Management and Policy Department, School of Public Health, University of Michigan, Ann Arbor, Michigan.
Insights
Physician rounding impacts hospital efficiency. Increasing rounding frequency for pediatric respiratory patients may decrease length of stay (LOS) but could affect patient education opportunities.
Area of Science:
- Pediatric healthcare research
- Hospital operations and efficiency
- Clinical informatics
Background:
- Hospital discharge processes differ between emergency departments (ED) and inpatient units.
- Physician-led rounds are a key factor in hospital discharges, but their impact on length of stay (LOS) is not well-quantified.
- Understanding discharge patterns is crucial for optimizing patient flow and resource allocation.
Purpose of the Study:
- To characterize arrival and discharge timing for pediatric respiratory illnesses in ED and inpatient settings.
- To investigate the potential influence of physician rounding frequency and timing on inpatient LOS.
- To identify opportunities for improving hospital efficiency in pediatric care.
Main Methods:
- Retrospective analysis of administrative data for pediatric respiratory visits to a tertiary care ED (May 2007-April 2010).
- Inclusion criteria focused on common respiratory conditions, excluding complex cases or intensive care admissions.
- Discharge and arrival times were analyzed, and a Monte Carlo simulation modeled the effect of increased rounding on LOS.
Main Results:
- Of 5503 visits, 23.4% led to inpatient admission.
- ED discharges occurred 2-5 hours post-arrival, while inpatient discharges clustered between 11 am and 6 pm.
- Simulated additional rounding sessions reduced predicted inpatient LOS by approximately 5 hours.
Conclusions:
- Pediatric inpatient discharges for respiratory illnesses are concentrated in the afternoon, unlike 24/7 ED discharges.
- Enhancing rounding frequency could improve hospital efficiency and reduce LOS.
- Potential trade-offs include reduced opportunities for patient education, necessitating careful implementation.
Background:
Patient discharge from the hospital is linked to physician-led rounds, whereas discharge from the emergency department (ED) is more fluid. The relationship between rounding and length of stay (LOS) has not been quantitatively described.
Objectives:
To describe the arrival and discharge patterns in the ED and inpatient settings for children with respiratory illnesses and to explore how the timing and frequency of rounding could impact LOS.
Design/Setting:
Retrospective administrative data analyses of visits for respiratory illnesses to a tertiary care pediatric ED from May 2007 to April 2010.
Methods:
ED visits for common respiratory conditions were selected based on International Classification of Diseases, 9th Revision, Clinical Modification codes, excluding complex comorbid conditions, severe illness, and intensive care unit admission. Discharge time was plotted against arrival time for the ED and inpatient unit. LOS was calculated. A Monte Carlo simulation model was developed to explore the influence of additional rounds on inpatient LOS.
Results:
Of the 5503 included visits, 1285 (23.4%) resulted in inpatient care. Discharges from the ED typically occurred 2 to 5 hours after arrival, whereas most inpatient discharges occurred between 11 am and 6 pm regardless of admission time. Simulating 1 additional rounding session decreased predicted inpatient LOS by approximately 5 hours.
Conclusions:
In contrast to ED discharges that occurred around the clock, inpatient discharges for children with respiratory illnesses were concentrated during afternoon hours. Increasing rounding frequency may improve hospital efficiency but could result in unintended consequences such as fewer opportunities for patient education.
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