Efficiency: Length of Stay and Readmission Rate
Why are these measures important?
When a child is hospitalized, he or she should stay in the hospital for the right length of time – long enough to treat the condition, but not longer than necessary. Too short a stay may mean that the child is not ready for discharge. Too long a stay disrupts the child’s life unnecessarily and may expose the child to unnecessary risks of hospitalization.
One measure of whether care is provided efficiently is the length of stay, or the number of days children spend in the hospital. Another way to determine whether care is provided efficiently is to track the readmission rate, or how often children need to be readmitted to the hospital within 72 hours of discharge.
In order to focus on the right length of stay, we always think of these two measures together when reviewing quality of care.
How do we track these measures?
Children’s Hospital Boston is part of a group of children’s hospitals throughout the country, which share their length of stay and readmission data. Through a central database, called the Pediatric Health Information System (PHIS), we can evaluate our data and compare ourselves with other children’s hospitals.
Children who are sicker may need to stay in the hospital longer and may be readmitted to the hospital more frequently than children who are less sick. Because Children’s Hospital Boston cares for many very sick children from throughout New England, it is important that we consider the level of illness of each child.
To do that, we use a statistical model that tries to adjust for how sick each child is. This adjustment helps us to better interpret our length of stay and hospital readmission data. We call this “risk adjustment.”
How do we compare to other hospitals?
Our median length of stay for all children admitted to the hospital for any reason in the first quarter of 2010 was 2.7 days, a decrease from 2.84 days in 2009 and equal to the median length of stay of our comparable children’s hospitals group (also 2.7 days). A median length of stay means that half of patients were in the hospital for more than 2.7 days, and half of patients were in the hospital for less than 2.7 days.
During the first quarter of 2010, our readmission rate was 3.03%, a decrease from 3.17% in 2009 but higher than the readmission rates of other children’s hospitals in our group (2.16%). Our goal is to bring our readmission rate down to 1%.
Why didn’t we set our readmission rate target at 0%?
The hospital is not a good place for children unless they are sick. To be sure that no patient is ever readmitted, we might have to keep many children in the hospital longer.
What are we doing to improve?
There are many quality improvement initiatives and programs underway to shorten the time children spend in the hospital while guaranteeing that they get the care they need to make a successful transition to home.
Among these initiatives are an emergency department program to ensure that patients are transferred from the emergency room to patient floors smoothly and quickly and an “Early Bird Discharge Program” which aims to discharge groups of patients by 9 a.m.
At the same time, we closely monitor readmission rates to make sure children are not being released from the hospital too soon. We contact all patients who have been readmitted to our hospital within three days of a previous discharge to find out why they needed to come back to the hospital. We are also working with outpatient and community providers to improve hospital-to-home transitions.
As an example of a solution for children with specific medical conditions, airway clearance treatments for patients with cystic fibrosis have been increased to four times a day as a result of a study showing that patients who received more frequent treatments were readmitted to the hospital less frequently.