Trends and Variation in the Use of Observation Stays at Children’s Hospitals

Author(s):  
Yao Tian ◽  
Matt Hall ◽  
Martha-Conley E Ingram ◽  
Andrew Hu ◽  
Mehul V Raval

BACKGROUND: Observation status could improve efficiency of healthcare resource use but also might shift financial burdens to patients and hospitals. Although the use of observation stays has increased for adult patient populations, the trends are unknown among hospitalized children. OBJECTIVE: The goal of this study was to describe recent trends in observation stays for pediatric populations at children’s hospitals. DESIGN, SETTING, AND PARTICIPANTS: Both observation and inpatient stays for all conditions were retrospectively studied using the Pediatric Health Information System database (2010 to 2019). EXPOSURE, MAIN OUTCOMES, AND MEASURES: Patient type was classified as inpatient or observation status. Main outcomes included annual percentage of observation stays, annual percentage of observation stays having prolonged length of stay (>2 days), and growth rates of observation stays for the 20 most common conditions. Risk adjusted hospital-level use of observation stays was estimated using generalized linear mixed-effects models. RESULTS: The percentage of observation stays increased from 23.6% in 2010 to 34.3% in 2019 (P < .001), and the percentage of observation stays with prolonged length of stay rose from 1.1% to 4.6% (P < .001). Observation status was expanded among a diverse group of clinical conditions; diabetes mellitus and surgical procedures showed the highest growth rates. Adjusted hospital-level use ranged from 0% to 67% in 2019, indicating considerable variation among hospitals. CONCLUSION: Based on the increase in observation stays, future studies should explore the appropriateness of observation care related to efficient use of healthcare resources and financial implications for hospitals and patients.

2020 ◽  
Vol 15 (7) ◽  
pp. 403-406
Author(s):  
Vineeta Mittal ◽  
Matt Hall ◽  
James Antoon ◽  
Jessica Gold ◽  
Chen Kenyon ◽  
...  

Intravenous (IV) magnesium is used as an adjunct therapy in management of status asthmaticus with a goal of reducing intubation rate. A recent review suggests that IV magnesium use in status asthmaticus reduces admission rates. This is contrary to the observation of practicing emergency room physicians. The goal of this study was to assess trends in IV magnesium use for status asthmaticus in US children’s hospitals over 8 years through a retrospective analysis of children younger than 18 years using the Pediatric Health Information System database. Outcomes were IV magnesium use, inpatient and intensive care unit admission rate, geometric mean length of stay, and 7-day all-cause readmission rate. IV magnesium use for asthma hospitalization more than doubled over 8 years (17% vs. 36%; P < .001). Yearly trends were not significantly associated with hospital or intensive care unit admission rate or 7-day all-cause readmissions, although length of stay was reduced (P < .001).


Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 341-341
Author(s):  
Courtney Kime ◽  
Jennifer Klima ◽  
Sarah O'Brien

Abstract Abstract 341 Background: A state of equipoise exists in the pediatric hematology community regarding the management of acute immune thrombocytopenic purpura (ITP). While studies have established that ITP treatment raises platelet counts, there is no evidence that treatment prevents serious hemorrhage. Recent guidelines from both an international expert panel and the American Society of Hematology recommend that children with no or mild bleeding be managed with observation alone, and hospitalization be reserved for those with clinically significant bleeding. There are no published data regarding current patterns of inpatient care for pediatric ITP, and the impact of guidelines on clinical practice cannot be determined unless a baseline is established. The objective of this study was to better understand current national practice patterns for acute ITP in United States children's hospitals and investigate regional differences in care. Methods: We examined data from the Pediatric Health Information System, a proprietary database containing clinical and financial data from 43 U.S. children's hospital. Hospitals were divided into regions based on U.S. Census divisions. Data were extracted for all inpatients with ITP (ICD-9 code 287.31) aged 1–18 years discharged in 2008–2010. As our aim was to describe practice patterns for newly diagnosed acute ITP, patients were excluded if they had an ITP-related admission within six months prior to the study period. In patients with multiple ITP admissions during the study period, only the first admission was analyzed. To minimize the number of patients with thrombocytopenia due to other causes (ITP coding errors), we excluded those with other diagnoses associated with thrombocytopenia, such as cancer and lupus. We compared treatment strategies, length of stay, readmissions within 60 days, and total charges by region. Statistical analyses included χ2 tests for categorical outcomes and Kruskal-Wallis tests for ordinal outcomes. Results: Between 2008 and 2010, we identified 2,314 unique patients meeting the study diagnosis of acute ITP (Table). Only 13.1% of patients had an ICD-9 code suggestive of significant bleeding, with epistaxis the most commonly reported symptom. Even in our hospitalized population, <1% of patients had a diagnosis code of intracranial hemorrhage. We identified significant variation (p<0.05) by geographic region in all examined parameters (treatment strategies, length of stay, hospital charges, and likelihood of readmission). In all geographic regions, IVIG was the most utilized treatment strategy. The use of IVIG as a solitary therapy ranged from 66.2% of patients in Pacific states to 85.0% of patients in the West North Central region (MN, MO, KS). Mean length of stay ranged from 1.0–2.0 days among regions, with mean total charges per admission ranging from $12,460 in the New England/Mid-Atlantic region to $21,623 in the West South Central region (AR, LA, TX). Pharmacy costs accounted for 50% of charges. Rates of readmission within 60 days of initial ITP admission ranged from 5.5%-14.4% of patients. Conclusions: This analysis of the Pediatric Health Information System identified geographic variability in the use of ITP therapies and costs of care for children hospitalized with acute ITP in U.S. children's hospitals. While our data source did not allow us to determine platelet count or indication for hospitalization, our results suggest that a large number of children admitted with ITP in recent years did not have clinically significant bleeding, and potentially could have been managed with outpatient observation. Future studies will be able to identify if the number of ITP admissions, costs of care, and geographic variability in care decrease with the dissemination and implementation of recently published clinical guidelines. Disclosures: No relevant conflicts of interest to declare.


Author(s):  
Kathleen Chiotos ◽  
Lauren D’Arinzo ◽  
Eimear Kitt ◽  
Rachael Ross ◽  
Jeffrey S. Gerber

OBJECTIVES Empirical broad-spectrum antibiotics are routinely administered for short durations to children with suspected bacteremia while awaiting blood culture results. Our aim for this study was to estimate the proportion of broad-spectrum antibiotic use accounted for by these “rule-outs.” METHODS The Pediatric Health Information System was used to identify children aged 3 months to 20 years hospitalized between July 2016 and June 2017 who received broad-spectrum antibiotics for suspected bacteremia. Using an electronic definition for a rule-out, we estimated the proportion of all broad-spectrum antibiotic days of therapy accounted for by this indication. Clinical and demographic characteristics, as well as antibiotic choice, are reported descriptively. RESULTS A total of 67 032 episodes of suspected bacteremia across 42 hospitals were identified. From these, 34 909 (52%) patients were classified as having received an antibiotic treatment course, and 32 123 patients (48%) underwent an antibiotic rule-out without a subsequent treatment course. Antibiotics prescribed for rule-outs accounted for 12% of all broad-spectrum antibiotic days of therapy. Third-generation cephalosporins and vancomycin were the most commonly prescribed antibiotics, and substantial hospital-level variation in vancomycin use was identified (range: 16%–58% of suspected bacteremia episodes). CONCLUSIONS Broad-spectrum intravenous antibiotic use for rule-out infections appears common across children’s hospitals, with substantial hospital-level variation in the use of vancomycin in particular. Antibiotic stewardship programs focused on intervening on antibiotics prescribed for longer durations may consider this novel opportunity to further standardize antibiotic regimens and reduce antibiotic exposure.


2021 ◽  
Vol 11 (6) ◽  
pp. 554-562
Author(s):  
Charlotte M. Brown ◽  
Derek J. Williams ◽  
Matt Hall ◽  
Katherine L. Freundlich ◽  
David P. Johnson ◽  
...  

2018 ◽  
Vol 84 (1) ◽  
pp. 12-19 ◽  
Author(s):  
Donald E. Fry ◽  
Michael Pine ◽  
Susan M. Nedza ◽  
Agnes M. Reband ◽  
Chun-Jung Huang ◽  
...  

More than 90 per cent of cholecystectomies are performed laparoscopically and this has resulted in concern that surgeons will not have sufficient experience to perform open procedures when clinical circumstances require it. We reviewed the open cholecystectomies (OCs) of Medicare patients from 2010 to 2012 in hospitals with 20 or more cases, created risk-adjusted models for adverse outcomes which were evaluated for 90-days after discharge, and compared the hospital-level outcomes with laparoscopic cholecystectomy performed in the same hospitals for the same period of time. Results demonstrated that inpatient deaths, inpatient prolonged length-of-stay outliers, 90-day postdischarge deaths without readmission, and 90-day readmissions were statistically the same with an overall adverse outcome rate of 21.6 per cent in OC versus 20.9 per cent in laparoscopic cholecystectomy. Conversion of laparoscopic to open procedures was not associated with increased adverse outcomes. Laparoscopic cholecystectomy provides patients with many advantages, but when clinical circumstances are necessary, OC continues to be performed with the same overall adverse outcome rates, and the conversion process is not associated with poorer results in this high-risk population of patients.


2012 ◽  
Vol 60 (3) ◽  
pp. 415-419 ◽  
Author(s):  
Anthony N. Audino ◽  
Nicholas D. Yeager ◽  
Lindsey Asti ◽  
Yongjie Miao ◽  
Sarah H. O'Brien

2016 ◽  
Vol 37 (8) ◽  
pp. 967-970 ◽  
Author(s):  
Monika Jelic ◽  
Amanda L. Adler ◽  
Arianna Miles-Jay ◽  
Scott J. Weissman ◽  
Matthew P. Kronman ◽  
...  

We used the Pediatric Health Information System database to assess the use of antibiotics reserved for the treatment of resistant Gram-negative infections in children from 2004 to 2014. Overall, use of these agents increased in children from 2004 to 2007 and subsequently decreased.Infect Control Hosp Epidemiol 2016:37:967–970


2016 ◽  
Vol 11 (5) ◽  
pp. 317-323 ◽  
Author(s):  
Kavita Parikh ◽  
Matt Hall ◽  
Anne J. Blaschke ◽  
Carlos G. Grijalva ◽  
Thomas V. Brogan ◽  
...  

JAMA ◽  
2011 ◽  
Vol 306 (13) ◽  
pp. 1454 ◽  
Author(s):  
Rustin B. Morse ◽  
Matthew Hall ◽  
Evan S. Fieldston ◽  
Gerd McGwire ◽  
Melanie Anspacher ◽  
...  

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