Tag Archives: Hospital Costs

Unplanned extubations in children: impact on hospital cost and length of stay. (Betters)

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Roddy DJ, Spaeder MC, Pastor W, Stockwell DC, Klugman D. Unplanned extubations in children: impact on hospital cost and length of stay. Pediatr Crit Care Med. 2015 Jul; 16(6):572-5.

Full-text for Children’s and Emory users.

OBJECTIVE: To determine the attributable hospital cost, both operational and departmental, and length of stay associated with unplanned extubations in children admitted to PICU and cardiac ICU.

DESIGN: Retrospective, matched case-control study.

SETTING: Forty-four-bed PICU and 26-bed cardiac ICU in a 303-bed tertiary care pediatric hospital.

PATIENTS: Cases with an unplanned extubation were retrospectively identified from July 2011 to March 2013. Controls were PICU and cardiac ICU patients admitted over the same time period and were matched at a ratio of 2:1 for age and diagnosis.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Forty-eight unplanned extubations were analyzed. There were no differences in patient demographics between the two groups, except the control group had a higher severity of illness as illustrated by a larger Paediatric Index of Mortality II Risk of Mortality. Median total hospital costs were higher in those patients with unplanned extubations as compared with controls ($101,310 vs $64,618; p < 0.001). Patients with an unplanned extubation had longer median ICU length of stay (10 d vs 4.5 d; p < 0.001) and hospital length of stay (16.5 d vs 10 d, p < 0.001).

CONCLUSION: Pediatric patients with unplanned extubations have an associated increase in hospital costs ($36,692/case) and length of stay (6.5 d/case) as compared with age and diagnosis-matched controls. Further efforts are warrant

Attributable cost and length of stay for central line-associated bloodstream infections. (Vats)

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Goudie A, Dynan L, Brady PW, Rettiganti M. Attributable cost and length of stay for central line-associated bloodstream infections. Pediatrics. 2014 Jun;133(6):e1525-32.

BACKGROUND AND OBJECTIVE: Central line-associated bloodstream infections (CLABSI) are common types of hospital-acquired infections associated with high morbidity. Little is known about the attributable cost and length of stay (LOS) of CLABSI in pediatric inpatient settings. We determined the cost and LOS attributable to pediatric CLABSI from 2008 through 2011.

METHODS: A propensity score-matched case-control study was performed. Children <18 years with inpatient discharges in the Nationwide Inpatient Sample databases from the Healthcare Cost and Utilization Project from 2008 to 2011 were included. Discharges with CLABSI were matched to those without CLABSI by age, year, and high dimensional propensity score (obtained from a logistic regression of CLABSI status on patient characteristics and the presence or absence of 262 individual clinical classification software diagnoses). Our main outcome measures were estimated costs obtained from cost-to-charge ratios and LOS for pediatric discharges.

RESULTS: The mean attributable cost and LOS between matched CLABSI cases (1339) and non-CLABSI controls (2678) was $55 646 (2011 dollars) and 19 days, respectively. Between 2008 and 2011, the rate of pediatric CLABSI declined from 1.08 to 0.60 per 1000 (P < .001). Estimates of mean costs of treating patients with CLABSI declined from $111 852 to $98 621 (11.8%; P < .001) over this period, but cost of treating matched non-CLABSI patients remained constant at ∼$48 000.

CONCLUSIONS: Despite significant improvement in rates, CLABSI remains a burden on patients, families, and payers. Continued attention to CLABSI-prevention initiatives and lower-cost CLABSI care management strategies to support high-value pediatric care delivery is warranted.

Full-text for Children’s and Emory users.