Tags

Type your tag names separated by a space and hit enter

Observation Encounters and Length of Stay Benchmarking in Children's Hospitals.
Pediatrics. 2020 11; 146(5)Ped

Abstract

BACKGROUND AND OBJECTIVES

Length of stay (LOS) is a common benchmarking measure for hospital resource use and quality. Observation status (OBS) is considered an outpatient service despite the use of the same facilities as inpatient status (IP) in most children's hospitals, and LOS calculations often exclude OBS stays. Variability in the use of OBS by hospitals may significantly impact calculated LOS. We sought to determine the impact of including OBS in calculating LOS across children's hospitals.

METHODS

Retrospective cohort study of hospitalized children (age <19 years) in 2017 from the Pediatric Health Information System (Children's Hospital Association, Lenexa, KS). Normal newborns, transfers, deaths, and hospitals not reporting LOS in hours were excluded. Risk-adjusted geometric mean length of stay (RA-LOS) for IP-only and IP plus OBS was calculated and each hospital was ranked by quintile.

RESULTS

In 2017, 45 hospitals and 625 032 hospitalizations met inclusion criteria (IP = 410 731 [65.7%], OBS = 214 301 [34.3%]). Across hospitals, OBS represented 0.0% to 60.3% of total discharges. The RA-LOS (SD) in hours for IP and IP plus OBS was 75.2 (2.6) and 54.3 (2.7), respectively (P < .001). For hospitals reporting OBS, the addition of OBS to IP RA-LOS calculations resulted in a decrease in RA-LOS compared with IP encounters alone. Three-fourths of hospitals changed ≥1 quintile in LOS ranking with the inclusion of OBS.

CONCLUSIONS

Children's hospitals exhibit significant variability in the assignment of OBS to hospitalized patients and inclusion of OBS significantly impacts RA-LOS calculations. Careful consideration should be given to the inclusion of OBS when determining RA-LOS for benchmarking, quality and resource use measurements.

Authors+Show Affiliations

Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee; james.gay@vumc.org.Children's Hospital Association, Lenexa, Kansas.Nationwide Children's Hospital, Columbus, Ohio. Department of Pediatrics, The Ohio State University, Columbus, Ohio.Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennyslvania. Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.Department of Pediatrics, Children's Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri.Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago Illinois; and. Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33023992

Citation

Gay, James C., et al. "Observation Encounters and Length of Stay Benchmarking in Children's Hospitals." Pediatrics, vol. 146, no. 5, 2020.
Gay JC, Hall M, Morse R, et al. Observation Encounters and Length of Stay Benchmarking in Children's Hospitals. Pediatrics. 2020;146(5).
Gay, J. C., Hall, M., Morse, R., Fieldston, E. S., Synhorst, D., & Macy, M. L. (2020). Observation Encounters and Length of Stay Benchmarking in Children's Hospitals. Pediatrics, 146(5). https://doi.org/10.1542/peds.2020-0120
Gay JC, et al. Observation Encounters and Length of Stay Benchmarking in Children's Hospitals. Pediatrics. 2020;146(5) PubMed PMID: 33023992.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Observation Encounters and Length of Stay Benchmarking in Children's Hospitals. AU - Gay,James C, AU - Hall,Matt, AU - Morse,Rustin, AU - Fieldston,Evan S, AU - Synhorst,David, AU - Macy,Michelle L, Y1 - 2020/10/06/ PY - 2020/06/04/accepted PY - 2020/10/8/pubmed PY - 2020/11/27/medline PY - 2020/10/7/entrez JF - Pediatrics JO - Pediatrics VL - 146 IS - 5 N2 - BACKGROUND AND OBJECTIVES: Length of stay (LOS) is a common benchmarking measure for hospital resource use and quality. Observation status (OBS) is considered an outpatient service despite the use of the same facilities as inpatient status (IP) in most children's hospitals, and LOS calculations often exclude OBS stays. Variability in the use of OBS by hospitals may significantly impact calculated LOS. We sought to determine the impact of including OBS in calculating LOS across children's hospitals. METHODS: Retrospective cohort study of hospitalized children (age <19 years) in 2017 from the Pediatric Health Information System (Children's Hospital Association, Lenexa, KS). Normal newborns, transfers, deaths, and hospitals not reporting LOS in hours were excluded. Risk-adjusted geometric mean length of stay (RA-LOS) for IP-only and IP plus OBS was calculated and each hospital was ranked by quintile. RESULTS: In 2017, 45 hospitals and 625 032 hospitalizations met inclusion criteria (IP = 410 731 [65.7%], OBS = 214 301 [34.3%]). Across hospitals, OBS represented 0.0% to 60.3% of total discharges. The RA-LOS (SD) in hours for IP and IP plus OBS was 75.2 (2.6) and 54.3 (2.7), respectively (P < .001). For hospitals reporting OBS, the addition of OBS to IP RA-LOS calculations resulted in a decrease in RA-LOS compared with IP encounters alone. Three-fourths of hospitals changed ≥1 quintile in LOS ranking with the inclusion of OBS. CONCLUSIONS: Children's hospitals exhibit significant variability in the assignment of OBS to hospitalized patients and inclusion of OBS significantly impacts RA-LOS calculations. Careful consideration should be given to the inclusion of OBS when determining RA-LOS for benchmarking, quality and resource use measurements. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/33023992/Observation_Encounters_and_Length_of_Stay_Benchmarking_in_Children's_Hospitals_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&amp;pmid=33023992 DB - PRIME DP - Unbound Medicine ER -