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Using Length of Stay to Understand Patient Flow for Pediatric Inpatients

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...

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Autores principales: Stockwell, David C., Thomas, Cherie, Fieldston, Evan S., Hall, Matt, Czaja, Angela S., Stalets, Erika L., Biehler, Jefry, Sheehan, Maeve, Foglia, Dorothy, Byrd, Susan, McClead, Richard E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6132698/
https://www.ncbi.nlm.nih.gov/pubmed/30229186
http://dx.doi.org/10.1097/pq9.0000000000000050
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author Stockwell, David C.
Thomas, Cherie
Fieldston, Evan S.
Hall, Matt
Czaja, Angela S.
Stalets, Erika L.
Biehler, Jefry
Sheehan, Maeve
Foglia, Dorothy
Byrd, Susan
McClead, Richard E.
author_facet Stockwell, David C.
Thomas, Cherie
Fieldston, Evan S.
Hall, Matt
Czaja, Angela S.
Stalets, Erika L.
Biehler, Jefry
Sheehan, Maeve
Foglia, Dorothy
Byrd, Susan
McClead, Richard E.
author_sort Stockwell, David C.
collection PubMed
description 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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spelling pubmed-61326982018-09-18 Using Length of Stay to Understand Patient Flow for Pediatric Inpatients Stockwell, David C. Thomas, Cherie Fieldston, Evan S. Hall, Matt Czaja, Angela S. Stalets, Erika L. Biehler, Jefry Sheehan, Maeve Foglia, Dorothy Byrd, Susan McClead, Richard E. Pediatr Qual Saf Multi-Institutional Collaborative and QI Network Research 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. Wolters Kluwer Health 2017-12-18 /pmc/articles/PMC6132698/ /pubmed/30229186 http://dx.doi.org/10.1097/pq9.0000000000000050 Text en Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CC-BY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Multi-Institutional Collaborative and QI Network Research
Stockwell, David C.
Thomas, Cherie
Fieldston, Evan S.
Hall, Matt
Czaja, Angela S.
Stalets, Erika L.
Biehler, Jefry
Sheehan, Maeve
Foglia, Dorothy
Byrd, Susan
McClead, Richard E.
Using Length of Stay to Understand Patient Flow for Pediatric Inpatients
title Using Length of Stay to Understand Patient Flow for Pediatric Inpatients
title_full Using Length of Stay to Understand Patient Flow for Pediatric Inpatients
title_fullStr Using Length of Stay to Understand Patient Flow for Pediatric Inpatients
title_full_unstemmed Using Length of Stay to Understand Patient Flow for Pediatric Inpatients
title_short Using Length of Stay to Understand Patient Flow for Pediatric Inpatients
title_sort using length of stay to understand patient flow for pediatric inpatients
topic Multi-Institutional Collaborative and QI Network Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6132698/
https://www.ncbi.nlm.nih.gov/pubmed/30229186
http://dx.doi.org/10.1097/pq9.0000000000000050
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