FOR IMMEDIATE RELEASE
WEDNESDAY, APRIL 5, 2000
CONTACT:
Patricia Enright
202-452-9511
STUDY FINDS THAT LENGTH OF HOSPITAL STAY GUIDELINES MAY BE INADEQUATE FOR PEDIATRIC PATIENTS
Children's National Medical Center physicians' study finds that widely used guidelines incorrectly target time in hospitals for children
Washington, DC (April 5, 2000) -- A new study published in the April issue of Pediatrics has found that the average length of stay (LOS) for pediatric inpatients in New York State in 1995 was markedly divergent from the widely accepted Milliman and Robertson (M&R) LOS guidelines. Because the study indicates that actual practice LOS was generally in excess of these guidelines, it raises questions about the potential effects of the guidelines on patients and the hospitals that treat them.
The study, titled "Pediatric Milliman and Robertson Length-of-Stay Criteria: Are They Realistic?," was designed to compare pediatric practice in a large and defined population to the 16 pediatric diagnoses for which M&R publishes guidelines. There are few existing reports that compare actual practice to such guidelines and none that examine pediatric populations.
When compared to the M&R guidelines, pediatric LOS in New York State during 1995 exceeded recommendations for medical admissions (croup: 23%, gastroenteritis: 44%, and pneumonia: 48%), admissions requiring surgery (uncomplicated appendectomy: 67%, pyloromyotomy: 62%, and major but non-critical burns: 64%), and prolonged treatment with antibiotics (bacterial meningitis: 91% and osteomyelitis: 86%). Another report which studied 25 surgical diagnoses had similar findings: in 8 of the 25 groups, the observed mean LOS exceeded M&R guidelines by greater than 5 days.
For example, children with a burst appendix had hospital stays averaging 12-13 days often with a 10-14 day course of antibiotics administered intravenously. M&R recommend a four-day stay for this condition. For bacterial meningitis the average hospital stay was 13 days, while M&R recommend a four-day stay.
"The discrepancies between M&R guidelines and observed LOS data calls attention to the methods used to develop and validate such recommendations," said study author Dr. Jill Joseph of Children's National Medical Center (CNMC) in Washington, D.C. "Length of stay guidelines are often based upon comparisons between hospitals or group consensus rather than . . . data."
In addition to examining pediatric LOS issues, the study raises questions about the lack of data available concerning patient outcomes after guideline implementation. Although systematic clinical cost-containment efforts have prompted the development and implementation of guidelines like those of M&R, the effects of the recommendations go largely unmeasured. Little is known about the guidelines' impact on health care costs, post-discharge care and the financial viability of health care facilities.
"While several studies have shown that LOS-related guidelines do not negatively impact patient health outcomes for average adults, we know very little about their effect on more vulnerable populations such as the elderly, young or chronically ill," added Dr. Joseph. "We endorse the need for cost-effective practice but stress that these goal-setting efforts be informed by epidemiological data and close attention to patient health and satisfaction."
This study is the lead article in the April, 2000 issue of the print version of Pediatrics. It is co-authored by Marion R. Sills, Zhihuan J. Huang, Cheng Shao, Mark F. Guagliardo, James M. Chamberlain, and Jill G. Joseph--all affiliated with CNMC.
Children's National Medical Center, located in Washington, D.C., is a leader in the development of innovative new treatments for childhood illness and injury. Among the top 15 pediatric hospitals in America, CNMC has been serving the nation's children for over 125 years. CNMC's newly developed Centers of Excellence programs include: Neurosciences and Behavioral Medicine; Cancer and Blood Disorders; Heart and Kidney Disease; Community Pediatric Health; Complex Diseases; Hospital Based Specialties, and Surgery. The Centers of Excellence program and an internationally recognized team of pediatric health care professionals allow Children's National Medical Center to care for thousands of families throughout the region, the nation, and the world. In addition, Children's serves as the regional referral center for pediatric emergency, trauma care, cancer, burn, neonatology, and critical care.
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For additional information on the Centers of Excellence program at Children's National Medical Center, please contact Patricia Enright at 202-452-9511 or via e-mail at: [email protected].
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