Trends in Length of Stay and Readmissions in Children’s Hospitals

Abstract

BACKGROUND AND OBJECTIVES: Patient complexity at US children’s hospitals is increasing. Hospitals experience concurrent pressure to reduce length of stay (LOS) and readmissions, yet little is known about how these common measures of resource use and quality have changed over time. Our aim was to examine temporal trends in medical complexity, hospital LOS, and readmissions across a sample of US children’s hospitals. METHODS: Retrospective cohort study of hospitalized patients from 42 children’s hospitals in the Pediatric Health Information System from 2013 to 2017. After excluding deaths, healthy newborns, obstetric care, and low volume service lines, we analyzed trends in medical complexity, LOS, and 14-day all-cause readmissions using generalized linear mixed effects models, adjusting for changes in patient factors and case-mix. RESULTS: Between 2013 and 2017, a total of 3 355 815 discharges were included. Over time, the mean case-mix index and the proportion of hospitalized patients with complex chronic conditions or receiving intensive care increased (P < .001 for all). In adjusted analyses, mean LOS declined 3% (61.1 hours versus 59.3 hours from 2013 to 2017, P < .001), whereas 14-day readmissions were unchanged (7.0% vs 6.9%; P = .03). Reductions in adjusted LOS were noted in both medical and surgical service lines (3.6% and 2.0% decline, respectively; P < .001). CONCLUSIONS: Across US children’s hospitals, adjusted LOS declined whereas readmissions remained stable, suggesting that children’s hospitals are providing more efficient care for an increasingly complex patient population.

Associations between comorbidity‐related functional limitations and pneumonia outcomes

“…Children with medical complexity account for nearly one‐third of all pediatric acute care hospitalizations and 40% of discharges from US children's hospitals 10,18 . Efforts to optimize pneumonia outcomes and improve overall care delivery in these children are critically important.…”

“…Children with medical complexity account for nearly one-third of all pediatric acute care hospitalizations and 40% of discharges from US children's hospitals. 10,18 Efforts to optimize pneumonia outcomes and improve overall care delivery in these children are critically important. Improved understanding of functional limitations among children with comorbidities could facilitate improved clinical decisionmaking, reduce outcome disparities, and inform research and quality efforts.…”

Morbidity and trends in length of hospitalisation of very and extremely preterm infants born between 2008 and 2021 in the Netherlands: a cohort study

“…1 3 4 Trends towards shorter hospital stays have been observed for many hospital populations within developed countries, attributed to enhanced patient outcomes and the delivery of more efficient care. [5][6][7] During the final decade of the previous century, the Vermont-Oxford Network and others reported similar trends of decreasing LoS at the NICU. 8 9 In more recent years, NICUs have implemented multiple interventions to facilitate the safe and earlier discharge of (very) preterm infants.…”

Burden of paediatric hospitalisations to the health care system, child and family: a systematic review of Australian studies (1990–2022)

“… 7 Similar findings for the younger age group (0–4 years) representing nearly half of admissions were reported in a US study. 8 In contrast, a UK study did not find any sociodemographic association other than medical complexity on LoS. 9 Although the above findings point to likely moderators of direct hospital costs, there has not been a systematic evaluation in the Australian context of how these characteristics may moderate costs for different admission reasons.…”