Analysis of the Effects of Applying Federal Diagnosis-Related Grouping (DRG) Guidelines to a Population of High-Risk Newborn Infants

PEDIATRICS ◽  
1985 ◽  
Vol 76 (1) ◽  
pp. 104-109
Author(s):  
Ronald L. Poland ◽  
Robert O. Bollinger ◽  
Mary P. Bedard ◽  
Sanford N. Cohen
Keyword(s):  
High Risk ◽  
Length Of Stay ◽  
Geometric Mean ◽  
Tertiary Care ◽  
Newborn Infants ◽  
Frequency Distributions ◽  
Federal Register ◽  
Children's Hospital ◽  
Lengths Of Stay ◽  
Children’S Hospital

Length of stay data collected for high-risk newborn infants admitted to a tertiary care children's hospital neonatal unit over a 6-year period were compared with mean and outlier lengths of stay published in the Federal Register as part of a proposed system for prospective payment of hospital cost by diagnosis-related groupings (DRGs). We found that the classification system for newborns markedly underestimated the number of days required for the treatment of these infants. The use of the geometric mean instead of the arithmetic mean as the measure of central tendency was a significant contributor to the discrepancy, especially in those sub-groups with bimodal frequency distributions of lengths of stay. Another contributor to the discrepancy was the lack of inborn patients in the children's hospital cohort. The system of prospective payments, as outlined, does not take into account several factors that have a strong influence on length of stay such as birth weight (which requires more than three divisions to serve as an effective predictor), surgery, outborn status, and ventilation. Implementation of the system described in the Federal Register would severely discourage tertiary care referral hospitals from providing neonatal intensive care.

Medical Device-related Pressure Injuries Associated With Electroencephalogram Leads in a Tertiary Care Children’s Hospital: A Retrospective Chart Review

2021 ◽  
Vol 67 (9) ◽  
pp. 25-32
Author(s):  
Christine Schindler ◽  
Rebekah Barrette ◽  
Aaron Sandcock ◽  
Evelyn Kuhn
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Medical Device ◽  
Tertiary Care ◽  
Interquartile Range ◽  
Hospital Data ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Pressure Injury

BACKGROUND: Medical device-related pressure injuries (MDRPIs) present a substantial safety risk for children who are hospitalized. PURPOSE: This study aimed to describe patient and clinical characteristics of children who develop MDRPIs related to electroencephalogram (EEG) leads, determine risk factors associated with their development, and determine if there are common risk factors that can lead to actionable strategies to reduce MDRPIs related to EEG leads. METHODS: A retrospective review was completed of the electronic health records of all 3136 children who had EEG lead placements between January 1, 2014, and April 16, 2018, at a large tertiary care children’s hospital. Data abstracted included demographic variables, patient and pressure injury characteristics, as well as length of stay. RESULTS: Twenty-four (24) of the 3136 children (0.8%) developed an MDRPI. Most were stage 2 pressure injuries. Patients who developed a pressure injury were significantly younger than patients who did not (median age, 0.9 and 5.2 years, respectively; P = .005). Fifty percent (50%) of all patients who developed pressure injuries were younger than 1 year of age compared with 27% of patients who did not develop pressure injuries. The median length of stay for patients in whom MDRPI developed was 84.5 days (interquartile range, 45–137) versus 3.0 days (interquartile range, 2–8) for those who did not develop an MDRPI (P < .001). The mortality rate during the hospital stay was 21% (n = 5) for those who developed MDPRIs versus 4% (n = 19) for those who did not (P = .002). All patients received standard preventive strategies. CONCLUSION: The incidence of MDRPIs in this patient population was significantly higher in younger and longer-stay patients, and their mortality rate was significantly higher. This suggests that the patients who developed an MDRPI were more critically ill than those who did not. Vigilant assessment and more research are needed to determine if there are appropriate strategies to reduce MDRPIs related to EEG lead placement.

scholarly journals Length of Stay in the Emergency Department during COVID-19 Pandemic in a Tertiary Care Hospital: A Descriptive Cross-sectional Study

2021 ◽  
Vol 59 (237) ◽  
Author(s):  
Suraj Singh ◽  
Bibek Koirala ◽  
Rabin Thami ◽  
Anupama Thapa ◽  
Bijay Thapa ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Sectional Study ◽  
Cross Sectional ◽  
Children's Hospital ◽  
Children’S Hospital

Introduction: Emergency Department overcrowding has become worsening problem internationally which may affect patient, emergency department efficiency and quality of care and this may lead to increased risk of in hospital mortality, higher costs, medical errors and longer times to treatment. With this pandemic COVID-19 likely to go on for months, if not a year or longer, the Emergency Department should be prepared for large influx of patients infected with COVID-19. The aim of this study is to find-out the length of stay in emergency department during COVID-19 pandemic at a tertiary care hospital in Nepal. Methods: This is a descriptive cross-sectional study conducted in the Emergency Department of Kanti Children’s Hospital. Ethical clearance was obtained from Institutional review committee Kanti Children’s Hospital. Data collection was done from the emergency records from July 23, 2020 to July 29, 2020. The calculated sample size was 211. The data thus obtained was entered in Statistical Package for the Social Science software version 20 and necessary calculations were done. Results: The median length of stay in emergency department was found to be 1.75 hours (Interquartile range 0 to 30 hours). Conclusions: Definitive management starts in respective wards and Intensive Care Units. During COVID-19, with longer emergency stay, chances of cross-infection increases, and the health workers serving in emergency department will be at risks. So guidelines for shorter emergency stay should be implemented.

Plasmodium vivaxmalaria admissions and risk of mortality in a tertiary-care children’s hospital in North India

2012 ◽  
Vol 32 (3) ◽  
pp. 152-157 ◽  
Author(s):  
Rajni Sharma ◽  
Suraj Gohain ◽  
Jagdish Chandra ◽  
Virendra Kumar ◽  
Abhishek Chopra ◽  
...  
Keyword(s):  
Tertiary Care ◽  
North India ◽  
Children's Hospital ◽  
Risk Of Mortality ◽  
Children’S Hospital

Prenatal Detection of Neuroblastoma: A Ten-Year Experience From the Dana-Farber Cancer Institute and Children's Hospital

PEDIATRICS ◽  
1993 ◽  
Vol 92 (3) ◽  
pp. 358-364
Author(s):  
Peter T.C. Ho ◽  
Judy A. Estroff ◽  
Harry Kozakewich ◽  
Robert C. Shamberger ◽  
Craig W. Lillehei ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Abdominal Mass ◽  
Tertiary Care ◽  
Prognostic Indicators ◽  
Adrenal Tumors ◽  
Prenatal Ultrasonography ◽  
Urinary Catecholamines ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Progression Of Disease

Objectives. To assess the relative frequency of, the clinical and pathological correlates in, and the prognosis of the subset of infants with neuroblastoma who were identified initially by prenatal ultrasonography. Design. Retrospective review of all patients with neuroblastoma evaluated between 1982 and 1992. Setting. Large, urban, tertiary care children's hospital in Boston, Massachusetts. Patients. Eleven infants with neuroblastoma initially detected with prenatal sonograms were identified. Results. Nine patients had adrenal tumors; two had thoracic paraspinal tumors. Typical diagnostic evidence for neuroblastoma including a palpable abdominal mass and elevations in urinary catecholamines were not commonly seen postnatally. These patients had multiple favorable prognostic indicators including low stage of disease (10/11), favorable biological markers including cellular DNA content (5/5) and N-myc oncogene copy number (5/5), and histopathology suggestive for neuroblastoma in situ (7/11). All patients were treated by surgical resection. One patient exhibited progression of disease postoperatively, but demonstrated a complete clinical response to multiagent chemotherapy. Overall survival in our population was excellent with no deaths seen at a mean follow-up of 37 months (range 3 to 120 months). Conclusions. Patients with neuroblastoma identified by prenatal ultrasonography generally, although not exclusively, follow a clinically favorable course in which surgical resection is curative. Chemotherapy is not indicated unless substantial progression of disease occurs.

scholarly journals Inequities in CLABSI Rates in a Children’s Hospital by Race, Ethnicity, and Language Preference

2021 ◽  
Vol 1 (S1) ◽  
pp. s43-s44
Author(s):  
Caitlin McGrath ◽  
Matthew Kronman ◽  
Danielle Zerr ◽  
Brendan Bettinger ◽  
Tumaini Coker ◽  
...  
Keyword(s):  
Reference Group ◽  
Tertiary Care ◽  
Central Line ◽  
Mucosal Barrier ◽  
Point Estimate ◽  
Language Preference ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Race Ethnicity ◽  
Clabsi Rate

Background: Systemic racism results in health inequities based on patient race, ethnicity, and language preference. Whether these inequities exist in pediatric central-line–associated bloodstream infections (CLABSIs) is unknown. Methods: This retrospective cohort study included patients with central lines hospitalized from October 2012 to June 2019 at our tertiary-care children’s hospital. Self-reported race, ethnicity, language preference, demographic, and clinical factors were extracted from the electronic health record. The primary outcome was non–mucosal barrier injury (non-MBI) CLABSI episodes as defined by the NHSN. CLABSI rates between groups were compared using χ2 tests and Cox proportional hazard regression. We adjusted for care unit, age, immunosuppressed status, diapered status, central-line type, line insertion within 7 days, daily CLABSI maintenance bundle compliance, number of blood draws and IV medication doses, and need for total parental nutrition, extracorporeal membrane oxygenation, and renal replacement therapy. In mid-2019, we engaged stakeholders in each care unit to describe preliminary findings and to identify and address potential drivers of observed inequities. Results: We included 337 non-MBI CLABSI events over 230,699 central-line days (CLDs). The overall non-MBI CLABSI rate during the study period was 1.46 per 1,000 CLDs. Unadjusted CLABSI rates for black or African American (henceforth, “black”), Hispanic, non-Hispanic white, and Asian (the 4 largest race or ethnicity groups by CLDs) patients were 2.74, 1.53, 1.42, 1.24 per 1,000 CLDs, respectively (P < .001) (Table 1). Unadjusted CLABSI rates for patients with limited-English proficiency (LEP) and English-language preference were 1.98 and 1.38 per 1,000 CLDs, respectively (P = .014). After adjusting for covariates, the hazard ratio (HR) point estimate for CLABSI rate remained higher for black patients (HR, 1.50; 95% CI, 0.99–2.28) and patients with LEP (HR, 1.33; 95% CI, 0.87–2.05), compared to the reference group based on largest CLD. The differences in CLABSI rate by race or ethnicity and language were more pronounced in 2 of our 6 care units. Stakeholder engagement and analysis of hospital data revealed opportunities on those units for improved (1) interpreter utilization and (2) line maintenance observation practices by race/ethnicity and language preference (data not shown). These findings and CLABSI rates over time by race/ethnicity and language preference (Figures 1 and 2) were shared with frontline staff. Conclusions: In our children’s hospital, CLABSI rates differed based on patients’ self-reported race, ethnicity, and language preference, despite controlling for factors commonly associated with CLABSI. Identifying inequities in CLABSI rates and mitigating their determinants are both essential to the goal of achieving equitable care.Funding: NoDisclosures: None

NEWS AND ANNOUNCEMENTS

PEDIATRICS ◽  
1972 ◽  
Vol 50 (3) ◽  
pp. 504-506
Keyword(s):  
Pediatric Cardiology ◽  
Medical Center ◽  
Newborn Infants ◽  
Heart Association ◽  
University Of Tennessee ◽  
Children's Hospital ◽  
Hospital Medical ◽  
Clinical Cardiology ◽  
Children’S Hospital ◽  
The University

Conference on Newborn Infants: The University of Tennessee College of Medicine will present the Fourth Memphis Conference on the Newborn at the Holiday Inn-Rivermont, Memphis, Tennessee, on September 21, 1972. Faculty will include Drs. Marshall Klaus, Leo Stern, and Paul Swyer. For further information write the Division of Continuing Education and Conferences, The University of Tennessee Medical Units, 800 Madison Avenue, Memphis, Tennessee 38103. Problems in Pediatric Cardiology: The American Heart Association Council on Clinical Cardiology, the Council on Rheumatic Fever and Congenital Heart Disease, and the Departments of Pediatrics, Surgery, and Pathology of Children's Hospital Medical Center and Harvard Medical School, in cooperation with the Massachusetts Heart Association, will cosponsor a course: Problems in Pediatric Cardiology, September 25-27, 1972, at Children's Hospital Medical Center, Boston, Massachusetts.

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