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Analysis

Shorter Hospital Stays Don't Increase Pediatric Readmissions

By Christopher Cheney  
   January 08, 2019

In adults, shortened length of stay has been linked to higher readmission rates for some conditions.

Shortening hospital length of stay does not increase readmission rates for pediatric patients, recent research shows.

For adults, length of stay has become a key metric for hospital readmissions, with concerns about the quality of discharge care such as patients discharged before they are ready to leave the hospital. Shortening hospitalization length of stay for adults is associated with a higher risk of readmission for some conditions.

The authors of the recent research, which was published in JAMA Pediatrics, say their finding likely reflects well-managed length of stay for pediatric patients.

"In children's hospitals, the majority of children may already be staying in the hospital for the appropriate amount of time. As a result, efforts to avoid readmissions should focus on other aspects of hospital discharge care," the researchers wrote.

The lead author of the research told HealthLeaders that most adults and children have fundamentally different length of stay experiences.

"When compared with adults, more pediatric hospitalizations are due to acute illnesses that are either self-limited or require interventions that can improve health with a short LOS. Adults with more chronic conditions may get more benefit from some additional time for improvement as well as discharge planning," said James Gay, MD, professor of pediatrics and medical director for utilization and case management, Monroe Carell Jr. Children's Hospital at Vanderbilt in Tennessee.

Gay and his team found little benefit from extending length of stay for pediatric patients.

"Keeping all children in the hospital longer may prevent some readmissions—as our study showed—but the cost is just too great for the relatively few readmissions prevented," Gay said.

Evaluating length of stay impact
 

Gay and his colleagues examined data from the Children's Hospital Association, including clinical and billing information from 49 children's hospitals.

The research team reviewed more than 950,000 pediatric hospitalizations.

  • There were 314 potential reasons for an admission and only six (1.9%) conditions had higher readmission rates with a shortened length of stay
     
  • The outlier conditions included asthma, cellulitis, and nephritis and nephrosis
     
  • The time estimated to prevent a single readmission ranged from 18 hospital-bed days for nephritis and nephrosis, to 148 days for newborns
     
  • The cost of preventing a single readmission through length of stay was prohibitive, ranging from $41,000 for nephritis and nephrosis to $1.4 million for dorsal and lumbar spinal fusion.

Rising to readmissions challenge
 

As they seek effective strategies to reduce readmissions, children's hospitals should be able to adopt some approaches from acute care hospitals, Gay said.

"In adults, improved discharge planning, follow-up telephone calls, and home visits have been shown to reduce readmissions for some patient populations. So, it seems logical that improved discharge planning and follow-up are potential targets for reducing preventable pediatric readmissions, too," he said.

Children's Hospitals will have to move cautiously, Gay said.

"Mounting evidence suggests that some post-discharge interventions such as follow-up home or office visits may actually be associated with more frequent readmissions in children. Is it just that the sicker patients—who are more likely to need readmission in the first place—are more likely to seek post-discharge care? Perhaps, but at this point, it's not clear and we continue to seek effective means of reducing pediatric readmissions."

Following length of stay best practices
 

Length of stay for individual patients should not be set rigidly, and providing efficient treatment in the hospital and effective discharge planning with the patient can safely shorten hospital stays, Gay said.

"We can shorten the LOS to the greatest extent possible while providing the patient with the best means to return to their previous health baseline," he said.

Some patients can go home earlier than others, Gay said. "We must remember that patients often do not require complete return to baseline while in the hospital and it may be appropriate for the recovery period to extend beyond the discharge date."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

Most adults and children have fundamentally different hospital length of stay experiences.

Length of stay at children's hospitals could be more properly calibrated than length of stay at acute care hospitals.

Some readmissions strategies for adults may not be effective for pediatric patients.


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