Long-stay patients

• Objective: To determine the characteristics and resource utilization associated with long-stay patients in academic children’s hospitals. • Study design and methods: Retrospective cohort study using the Pediatric Health Information System database, which includes data from 34 noncompeting children’s hospitals in the United States. We defined long-stay patients as those with a length of stay (LOS) 2 standard deviations above the mean. For each discharge, demographic, clinical, and resource characteristics were identified. Chi-square tests, t tests, and logistic regression models were used to test the relationships between these characteristics and LOS for all long-stay patients and separately for neonatal (age ≤ 30 days) and pediatric long-stay patients. • Results: Long-stay patients comprised 2.4% of the population but represented 27.9% of hospital days and 30.2% of adjusted charges. A total of 81.9% of long-stay patients were discharged home. Death occurred in 6.7% of neonatal and 8.4% of pediatric long-stay patients. Mean adjusted charges between age-groups did not differ. Neonatal long-stay patients had an actual LOS and adjusted charges 2 times greater than expected. For pediatric long-stay patients, these variables were 4 times greater than expected. Female sex, black race, age < 30 days, increased severity of illness, complication or infection during hospitalization, and the need for additional care upon discharge increased the likelihood of prolonged LOS. • Conclusions: Long-stay patients in academic children’s hospitals are rare but account for a significant proportion of hospital days and charges. Pediatric long-stay patients are responsible for a disproportionate share of increased charges. Improved case management of prolonged hospitalizations may reduce charges and improve quality of care. The current health care environment mandates the efficient use of hospital resources to contain costs without compromising the quality of care. Length of stay (LOS) is a proxy for both efficiency and quality and is a major target for cost containment. Efficiency analyses in both adult and pediatric critical care have identified a unique population of patients who are extreme outliers for LOS. Several studies demonstrate that for both medical and surgical patients of all ages, long-stay patients in the intensive care unit (ICU) comprise a small portion of the patient population but consume a disproportionate share of resources [1–­7]. In many cases, long-stay patients are more likely to have negative outcomes, such as significantly higher mortality rates, than patients with shorter stays. Higgins et al [6] and Marcin et al [7] found that a variety of clinical and organizational factors were early indicators of prolonged LOS in the ICU. In both studies, the authors present predictive algorithms to allow for the prospective identification of patients at high risk for prolonged stays. They propose the early implementation of strategies aimed at improving both the efficiency and quality of care for these patients. Long-stay patients in pediatric hospitals may also represent a unique patient population. Several clinical and organizational determinants of LOS for hospitalized pediatric patients have been identified [1,8–­15]. In addition, Chabra and Chavez [16] found that although the rate of long pediatric hospitalizations in all nonfederal acute care hospitals in California declined between 1985 and 1994, there remained a small population of patients with prolonged LOS who accounted for a significant proportion of patient days. However, resource use was not measured and no comparison was made between the characteristics of patients with prolonged stays and those without prolonged stays. A contemporary investigation that describes the population of patients with prolonged stays in pediatric academic hospitals and their associated resource use has not been performed. Long-Stay Patients in Academic Children’s Hospitals