Population variation in admission rates and duration of inpatient stay for bronchiolitis in England

Abstract

We postulate that healthcare provider factors manifested by variation in clinical decision-making (including thresholds for admission and discharge, and variation in therapies) are responsible at least in part for variation in rate of admission and length of stay for children with bronchiolitis in England.

Variability in Inpatient Management of Children Hospitalized With Bronchiolitis

“…Evidence suggests that variations in clinical care delivery processes for bronchiolitis, including the threshold for oxygen supplementation and criteria for admission and discharge have a significant impact on length of stay. 12,13 However, multiple factors effect length of hospital stay for children with bronchiolitis. 14 Nonetheless, the aggregate effect of these variations in delivery of care coupled with the variation in diagnostic testing and management seen in this study highlights inefficiency and ineffectiveness within systems of care.…”

“…[9][10][11] Similarly, variability in admission, discharge decisions, and therapy have contributed to variability in the rate of admission and length of stay. 12 Isolated efforts at minimizing variation in these settings have demonstrated decreases in inpatient treatment variation and improved outcomes for bronchiolitis. 13 The extent of variation between hospitals and its relationship to patient specific characteristics, including clinical risk factors, remains uncertain.…”

Assessing efficient patient care: should length of stay be calculated independently of local admission rates?

“…However, in most unplanned medical admissions, admission criteria are subjective and variable 6. In bronchiolitis, recently published data have shown a wide variation in admission rates and length of stay between hospitals across the UK7 and the frequency of short stay admissions in paediatrics generally also seems to be increasing 8. Variations in admission rates, particularly if more ‘well’ patients are admitted, will affect the length of stay and potentially confound this as a measurement of efficiency.…”

Stemming the tide of hospital admissions for bronchiolitis

“…This theory is supported by the degree of geographical variation observed, which is only weakly attributable to sociodemographic factors—particularly for a condition in which supportive care is the only proven effective therapy 1 5…”

“…Rising hospital admissions, which may be symptomatic of lower clinical thresholds for admission, have been shown to have a negative correlation with LoS. There is recent evidence that LoS for bronchiolitis is low, with median LoS for bronchiolitis in the UK in 2007/2008 being only 1 day long 4 5…”