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Using Length of Stay to Understand Patient Flow for Pediatric Inpatients
David C Stockwell1, Cherie Thomas1, Evan S Fieldston1
1Division of Critical Care Medicine, Department of Pediatrics, The George Washington University, School of Medicine, Washington, D.C.; Department of Quality Improvement, Children's Hospital Association, Washington, D.C.; Department of Pediatrics, The Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.; Division of Analytics, Children's Hospital Association, Washington, D.C.; Department of Pediatrics, Section of Critical Care, University of Colorado School of Medicine, Aurora, Colo.; Department of Pediatrics, Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, Herbert Wertheim College of Medicine, Florida International University, Miami, Fla.; Division of Emergency Medicine, Nicklaus Children's Hospital, Miami, Fla.; Department of Pediatrics, UT Southwestern Medical Center, Dallas, Tex.; Children's Medical Center, Children's Health, Dallas, Tex.; Department of Nursing, All Children's Hospital, St. Petersburg, Fla.; Division of Neonatology, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio; and Office of the Chief Medical Officer, Nationwide Children's Hospital, Columbus, Ohio.
Insights
A new metric was developed to assess pediatric inpatient flow variability using observed-to-expected length of stay and rehospitalization rates. This metric helps hospitals evaluate their performance in managing patient flow.
Area of Science:
- Healthcare Management
- Pediatric Hospital Operations
- Health Services Research
Background:
- Inpatient flow is crucial for pediatric hospital efficiency.
- Existing metrics may not fully capture meaningful variability in patient flow.
- Assessing performance requires robust and reliable measures.
Purpose of the Study:
- To develop and validate a novel metric for evaluating inpatient flow variability in pediatric hospitals.
- To incorporate length of stay and rehospitalization data into a comprehensive performance measure.
- To provide a tool for pediatric hospitals to benchmark and improve operational efficiency.
Main Methods:
- Utilized the Pediatric Health Information System dataset (2013) from 38 pediatric hospitals.
- Created two composite groups: Acute Care Composite (ACC) and ICU Composite (ICUC) based on diagnoses and ICU stay.
- Incorporated observed-to-expected length of stay (LOS), excess LOS percentage, and 7-day rehospitalization rates into the metric.
Main Results:
- The ACC included 113,768 hospitalizations; ICUC included 38,400.
- ACC: median O/E LOS 1.0, median excess LOS 23.9%, rehospitalization 1.7%.
- ICUC: median O/E LOS 1.1, median excess LOS 32.3%, rehospitalization 4.9%. No O/E LOS and rehospitalization relationship found.
Conclusions:
- The developed metric effectively demonstrates inter-hospital variation in inpatient flow.
- This metric can empower pediatric hospitals to assess and enhance their inpatient flow performance.
- Further research may refine the metric for broader application.
Objectives:
Develop and test a new metric to assess meaningful variability in inpatient flow.
Methods:
Using the pediatric administrative dataset, Pediatric Health Information System, that quantifies the length of stay (LOS) in hours, all inpatient and observation encounters with 21 common diagnoses were included from the calendar year 2013 in 38 pediatric hospitals. Two mutually exclusive composite groups based on diagnosis and presence or absence of an ICU hospitalization termed Acute Care Composite (ACC) and ICU Composite (ICUC), respectively, were created. These composites consisted of an observed-to-expected (O/E) LOS as well as an excess LOS percentage (ie, the percent of day beyond expected). Seven-day all-cause risk-adjusted rehospitalizations was used as a balancing measure. The combination of the ACC, the ICUC, and the rehospitalization measures forms this new metric.
Results:
The diagnosis groups in the ACC and the ICUC included 113,768 and 38,400 hospitalizations, respectively. The ACC had a median O/E LOS of 1.0, a median excess LOS percentage of 23.9% and a rehospitalization rate of 1.7%. The ICUC had a median O/E LOS of 1.1, a median excess LOS percentage of 32.3%, and rehospitalization rate of 4.9%. There was no relationship of O/E LOS and rehospitalization for either ACC or ICUC.
Conclusions:
This metric shows variation among hospitals and could allow a pediatric hospital to assess the performance of inpatient flow.
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