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Defining criteria and resource use for high dependency care in children: an observational economic study
Kevin P Morris1, Raymond Oppong2, Nicola Holdback1
1Paediatric Intensive Care, Birmingham Children's Hospital, Birmingham, UK.
Insights
New UK Healthcare Resource Group (HRG) criteria for paediatric high dependency care (HDC) effectively identify children requiring more staff resources. A revised definition reduced case numbers but highlighted a group with significantly higher resource consumption.
Area of Science:
- Healthcare Management
- Paediatric Critical Care
- Health Economics
Background:
- International consensus on defining and funding paediatric high dependency care (HDC) is lacking.
- Accurate classification is crucial for resource allocation and patient management in paediatric HDC.
Purpose of the Study:
- To evaluate a new UK Healthcare Resource Group (HRG) classification for paediatric HDC.
- To determine if the HRG classification can identify children with higher staff resource needs.
- To assess the impact of revised basic HDC HRG criteria implemented in April 2011.
Main Methods:
- Observational study analyzing medical and nursing staff resource use.
- Data collected from 16 paediatric wards across 6 hospitals, including 1 tertiary children's hospital.
- 1098 infants and children were included, with staff costs extrapolated from bedside time.
Main Results:
- Initially, 20.3% of children met HDC criteria (15.9% basic, 4.4% advanced).
- Revised criteria reduced this to 8.0% (3.6% basic, 4.4% advanced).
- Children meeting HDC criteria consumed significantly more staff resources (cost ratios 1.0:1.75:2.96 pre-revision, 1.0:2.35:2.76 post-revision).
Conclusions:
- The HDC HRG criteria successfully identify children with higher staff resource needs.
- The revision significantly reduced the number of cases classified as HDC.
- Despite the reduction, the revised criteria still identify a distinct group with substantially greater staff resource utilization.
Objectives:
Internationally there is no consensus on defining and funding of paediatric high dependency care (HDC). This study tested whether a new UK Healthcare Resource Group (HRG) classification for HDC, with two categories of basic and advanced HDC, can identify children who consume greater staff resource. It also explored the impact of a change in basic HDC HRG criteria introduced in April 2011.
Design:
Observational study of medical and nursing staff resource use.
Setting:
16 paediatric wards across 6 regional hospitals; 1 tertiary children's hospital (November 2010 to March 2011).
Participants:
1098 infants and children admitted to paediatric wards.
Main Outcome Measures:
Number of children meeting criteria for basic and advanced HDC HRGs; care in a cubicle; medical and nursing staff costs, extrapolated from time spent at patient bedside.
Results:
223 (20.3%) children met original HDC criteria (15.9% basic, 4.4% advanced). This fell to 88 (8.0%) with the change in basic HDC definition (3.6% basic, 4.4% advanced). Children who met original HDC criteria consumed greater bedside staff resource than those not meeting criteria (cost ratio 1.0:1.75:2.96 (non-HDC:basic HDC:advanced HDC)), with revised criteria identifying a (smaller) basic group with greater staff resource use (cost ratio 1.0:2.35:2.76). Being cared for in a cubicle was not associated with greater staff costs.
Conclusions:
HDC HRG criteria identify children who consume significantly greater staff resources. Revision of the definition has resulted in a large reduction of cases meeting the criteria but identifies a group consuming greater staff resources.
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