Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee;
Children's Hospital Association, Lenexa, Kansas.
Pediatrics. 2020 Nov;146(5). doi: 10.1542/peds.2020-0120. Epub 2020 Oct 6.
Length of stay (LOS) is a common benchmarking measure for hospital resource use and quality. Observation status (OBS) is considered an outpatient service despite the use of the same facilities as inpatient status (IP) in most children's hospitals, and LOS calculations often exclude OBS stays. Variability in the use of OBS by hospitals may significantly impact calculated LOS. We sought to determine the impact of including OBS in calculating LOS across children's hospitals.
Retrospective cohort study of hospitalized children (age <19 years) in 2017 from the Pediatric Health Information System (Children's Hospital Association, Lenexa, KS). Normal newborns, transfers, deaths, and hospitals not reporting LOS in hours were excluded. Risk-adjusted geometric mean length of stay (RA-LOS) for IP-only and IP plus OBS was calculated and each hospital was ranked by quintile.
In 2017, 45 hospitals and 625 032 hospitalizations met inclusion criteria (IP = 410 731 [65.7%], OBS = 214 301 [34.3%]). Across hospitals, OBS represented 0.0% to 60.3% of total discharges. The RA-LOS (SD) in hours for IP and IP plus OBS was 75.2 (2.6) and 54.3 (2.7), respectively ( < .001). For hospitals reporting OBS, the addition of OBS to IP RA-LOS calculations resulted in a decrease in RA-LOS compared with IP encounters alone. Three-fourths of hospitals changed ≥1 quintile in LOS ranking with the inclusion of OBS.
Children's hospitals exhibit significant variability in the assignment of OBS to hospitalized patients and inclusion of OBS significantly impacts RA-LOS calculations. Careful consideration should be given to the inclusion of OBS when determining RA-LOS for benchmarking, quality and resource use measurements.
住院时间（LOS）是衡量医院资源利用和质量的常用基准。观察状态（OBS）被视为门诊服务，尽管在大多数儿童医院中，它与住院状态（IP）使用相同的设施，但 LOS 计算通常不包括 OBS 住院时间。医院对 OBS 的使用情况存在差异，这可能会对计算得出的 LOS 产生重大影响。我们旨在确定在计算 LOS 时将 OBS 纳入其中对儿童医院的影响。
对 2017 年儿科健康信息系统（堪萨斯州莱内克斯的儿童健康协会）中住院的儿童（年龄<19 岁）进行回顾性队列研究。排除正常新生儿、转院、死亡以及未报告以小时为单位 LOS 的医院。计算仅 IP 和 IP 加 OBS 的风险调整几何平均 LOS（RA-LOS），并按五分位数对每家医院进行排名。
2017 年，45 家医院和 625032 例住院符合纳入标准（IP = 410731[65.7%]，OBS = 214301[34.3%]）。在各家医院中，OBS 占总出院人数的 0.0%至 60.3%。IP 和 IP 加 OBS 的 RA-LOS（SD）分别为 75.2（2.6）和 54.3（2.7）（<0.001）。对于报告 OBS 的医院，与仅 IP 就诊相比，将 OBS 纳入 IP RA-LOS 计算会导致 RA-LOS 降低。有 3/4 的医院在 LOS 排名中变化了≥1 个五分位数，而纳入 OBS。
儿童医院在将 OBS 分配给住院患者方面存在显著差异，并且纳入 OBS 会显著影响 RA-LOS 计算。在确定用于基准测试、质量和资源利用测量的 RA-LOS 时，应仔细考虑纳入 OBS。
