Trends in Length of Stay and Readmissions in Children's Hospitals.

TitleTrends in Length of Stay and Readmissions in Children's Hospitals.
Publication TypeJournal Article
Year of Publication2021
AuthorsBrown CM, Williams DJ, Hall M, Freundlich KL, Johnson DP, Lind C, Rehm K, Frost PA, Doupnik SK, Ibrahim D, Patrick S, Howard LM, Gay JC
JournalHosp Pediatr
Date Published2021 May 04
ISSN2154-1671
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 ( < .001 for all). In adjusted analyses, mean LOS declined 3% (61.1 hours versus 59.3 hours from 2013 to 2017, < .001), whereas 14-day readmissions were unchanged (7.0% vs 6.9%; = .03). Reductions in adjusted LOS were noted in both medical and surgical service lines (3.6% and 2.0% decline, respectively; < .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.

DOI10.1542/hpeds.2020-004044
Alternate JournalHosp Pediatr
PubMed ID33947746