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Appropriateness of hospitalization in a Canadian pediatric hospital
J E Gloor1, N Kissoon, G I Joubert
1University of Western Ontario, Children's Hospital of Western Ontario, London, Canada.
Insights
A Canadian study found 24% of pediatric patient days in hospital were inappropriate. Younger children and shorter stays had more appropriate days, similar to US findings.
Area of Science:
- Pediatric Health Services Research
- Health Economics
- Quality Improvement in Healthcare
Background:
- Limited resources in Canadian healthcare necessitate studies on pediatric patient day appropriateness.
- Previous research in the United States established a Pediatric Appropriateness Evaluation Protocol.
Purpose of the Study:
- To retrospectively evaluate the appropriateness of pediatric inpatient days in a Canadian hospital.
- To compare findings with existing US data on pediatric hospital day appropriateness.
Main Methods:
- Retrospective chart review of one hospital day per month in 1988.
- Utilized the US Pediatric Appropriateness Evaluation Protocol.
- Analyzed 852 inpatient charts across various age groups and services.
Main Results:
- Twenty-four percent of reviewed pediatric patient days were deemed inappropriate.
- Younger children (infants < 60 days) and shorter lengths of stay (≤ 2 days) showed higher appropriateness.
- Inappropriate days increased with age and length of hospitalization; surgical patients had more appropriate days than medical patients.
Conclusions:
- Inappropriate hospitalization in Canadian pediatric facilities is comparable to US rates.
- Age and length of stay are significant factors influencing hospital day appropriateness.
- Further research is needed to optimize resource allocation in pediatric care.
Abstract:
Allocation of limited resources in the Canadian health care system is hampered by a lack of studies addressing the appropriateness of the pediatric patient days in hospital. The authors retrospectively reviewed one hospital day per month in 1988, using a Pediatric Appropriateness Evaluation Protocol previously used in the United States. Of 878 inpatients, 852 charts were reviewed, and 26 charts were unavailable for study. The patients ranged in age from premature newborns to 20 years old. There were 475 medical days, 359 surgical days, and 18 patients to other services. Statistical significance was tested using the chi 2 test for contingency tables. Twenty-four percent of patient days were inappropriate. Younger children and shorter lengths of stay were more likely to result in appropriate hospital days. For infants younger than 60 days, 11% of days in hospital were inappropriate, 21% of days for infants between 2 months and 1 year of age, 25% for children between 1 and 5 years, and 36% for children older than 5 years of age. Children hospitalized 2 days or less had inappropriate hospital days accounting for 16% of the reviewed days. This increased to 33% for 3 to 14 days of hospitalization. Inappropriate hospital days did not vary significantly from month to month. Surgical patients had more appropriate hospital days than medical patients. Admission route (elective, emergency, or transferred from another hospital) did not affect the appropriateness of the subsequent day reviewed. It is concluded that inappropriate hospitalization in a Canadian pediatric hospital occurs only slightly more frequently than in an American pediatric hospital.(ABSTRACT TRUNCATED AT 250 WORDS)