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Short stay unit led by pediatric hospital medicine advanced practice providers
Brittany K Potts1,2, Jonathan H Pelletier2,3, Leah Rawdon1
1Division of Hospital Medicine, Akron Children's Hospital, Akron, Ohio, USA.
Insights
A pilot advanced practice provider-run short stay unit reduced pediatric length of stay and costs for common conditions like asthma and dehydration. This innovative model improved efficiency without impacting 7-day emergency department revisit rates.
Area of Science:
- Pediatric Hospital Medicine
- Healthcare Operations
- Quality Improvement
Background:
- A critical pediatric bed shortage in 2022 necessitated innovative solutions for timely patient care.
- A pilot program for an advanced practice provider (APP)-run short stay unit (SSU) was proposed for select pediatric hospital medicine (PHM) patients.
Purpose of the Study:
- To compare the length of stay (LOS) and associated costs before and after the implementation of a PHM APP-led SSU pilot at a tertiary pediatric hospital.
Main Methods:
- A single-center prospective pilot observational cohort study with historical controls was conducted.
- Observation encounters for patients with asthma, bronchiolitis, croup, and dehydration were included.
- An independent-practice model SSU staffed by APPs on the PHM service was implemented and compared to pre-SSU encounters.
Main Results:
- Median unit LOS decreased from 21 hours to 18 hours (p < .001), and standardized unit cost decreased from $3593 to $2958 (p < .001).
- After matching, the APP-led SSU resulted in an average reduction of 3.88 hours in LOS and $593 in cost.
- No significant differences were observed in 7-day emergency department (ED) revisit rates between the SSU and pre-SSU cohorts.
Conclusions:
- The APP-run SSU pilot successfully reduced LOS and costs for pediatric patients with common conditions.
- This model demonstrates an effective strategy for managing patient flow and resource utilization in pediatric hospital medicine.
- The APP-led SSU provides a safe and efficient alternative, maintaining quality of care without increasing revisits.
Background:
In response to a critical pediatric bed shortage in 2022, an urgent process change was required to provide safe and timely medical care. We proposed a pilot for an advanced practice provider (APP)-run short stay unit (SSU) for select pediatric hospital medicine (PHM) patients.
Objective:
To compare length of stay (LOS) and cost before and after implementation of a PHM APP-led SSU pilot at a tertiary pediatric hospital.
Designs, Settings, And Participants:
Single-center prospective pilot observational cohort study with historical control. Observation encounters for patients with asthma, bronchiolitis, croup, and dehydration were included.
Intervention:
An independent-practice model SSU staffed by APPs on the PHM service.
Main Outcome And Measures:
SSU encounters (September 1, 2022-December 1, 2022) were compared against pre-SSU encounters (September 1, 2021-August 31, 2022). Cohorts were described with summary statistics. SSU encounters were matched against pre-SSU encounters based on demographics and diagnosis, and the average effect of treatment was calculated. LOS was abstracted from the enterprise data warehouse and standardized unit cost from the Pediatric Health Information Systems database.
Results:
There were 1110 encounters included, 155 in the SSU cohort and 955 in the pre-SSU cohort: 24.2% asthma, 30.8% bronchiolitis, 8.3% croup, and 36.7% dehydration. Median (interquartile range) unit LOS decreased from 21 (16-26) to 18 (10-22) h, p < .001. Cost decreased from $3593 ($3031-$4560) to $2958 ($2278-$3856), p < .001. After matching, the average treatment effect was reduction of 3.88 h (95% confidence interval [CI] 1.91-5.85) and $593 (95% CI $348-$839). There were no significant differences in 7-day ED revisit rates.
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