C DeRienzo1,2,3, J A Kohler3, E Lada4, P Meanor4, D Tanaka3. 1. Mission Health System, Administration, Asheville, NC, USA. 2. Mission Children's Specialists, Asheville, NC, USA. 3. Duke University Hospital, Division of Neonatal-Perinatal Medicine, Durham, NC, USA. 4. Advanced Analytics Division, SAS, Cary, NC, USA.
Abstract
OBJECTIVE: Health-care leaders place significant focus on reducing the average length of stay (ALOS). We examined the relationships among ALOS, cost and clinical outcomes using a neonatal intensive care unit (NICU) simulation model. STUDY DESIGN: A discrete-event NICU simulation model based on the Duke NICU was created. To identify the relationships among ALOS, cost and clinical outcomes, we replaced the standard probability distributions with composite distributions representing the best and worst outcomes published by the National Institutes of Health Neonatal Research Network. RESULT: Both average cost per patient and average cost per ⩽28 week patient were lower in the best NICU ($16,400 vs $19,700 and $56,800 vs $76,700, respectively), while LOS remained higher (27 vs 24 days). CONCLUSION: Our model demonstrates that reducing LOS does not uniformly reduce hospital resource utilization. These results suggest that health-care leaders should not simply rely on initiatives to reduce LOS without clear line-of-sight on clinical outcomes as well.
OBJECTIVE: Health-care leaders place significant focus on reducing the average length of stay (ALOS). We examined the relationships among ALOS, cost and clinical outcomes using a neonatal intensive care unit (NICU) simulation model. STUDY DESIGN: A discrete-event NICU simulation model based on the Duke NICU was created. To identify the relationships among ALOS, cost and clinical outcomes, we replaced the standard probability distributions with composite distributions representing the best and worst outcomes published by the National Institutes of Health Neonatal Research Network. RESULT: Both average cost per patient and average cost per ⩽28 week patient were lower in the best NICU ($16,400 vs $19,700 and $56,800 vs $76,700, respectively), while LOS remained higher (27 vs 24 days). CONCLUSION: Our model demonstrates that reducing LOS does not uniformly reduce hospital resource utilization. These results suggest that health-care leaders should not simply rely on initiatives to reduce LOS without clear line-of-sight on clinical outcomes as well.
Authors: C Michael Cotten; William Oh; Scott McDonald; Waldemar Carlo; Avroy A Fanaroff; Shahnaz Duara; Barbara Stoll; Abbot Laptook; Kenneth Poole; Linda L Wright; Ronald N Goldberg Journal: J Perinatol Date: 2005-10 Impact factor: 2.521
Authors: Barbara J Stoll; Nellie I Hansen; Edward F Bell; Seetha Shankaran; Abbot R Laptook; Michele C Walsh; Ellen C Hale; Nancy S Newman; Kurt Schibler; Waldemar A Carlo; Kathleen A Kennedy; Brenda B Poindexter; Neil N Finer; Richard A Ehrenkranz; Shahnaz Duara; Pablo J Sánchez; T Michael O'Shea; Ronald N Goldberg; Krisa P Van Meurs; Roger G Faix; Dale L Phelps; Ivan D Frantz; Kristi L Watterberg; Shampa Saha; Abhik Das; Rosemary D Higgins Journal: Pediatrics Date: 2010-08-23 Impact factor: 7.124
Authors: Ruben L Osnabrugge; Alan M Speir; Stuart J Head; Philip G Jones; Gorav Ailawadi; Clifford E Fonner; Edwin Fonner; A Pieter Kappetein; Jeffrey B Rich Journal: J Thorac Cardiovasc Surg Date: 2014-08-06 Impact factor: 5.209
Authors: J A Rogowski; J D Horbar; P E Plsek; L S Baker; J Deterding; W H Edwards; J Hocker; A D Kantak; P Lewallen; W Lewis; E Lewit; C J McCarroll; D Mujsce; N R Payne; P Shiono; R F Soll; K Leahy Journal: Pediatrics Date: 2001-01 Impact factor: 7.124
Authors: J D Horbar; J Rogowski; P E Plsek; P Delmore; W H Edwards; J Hocker; A D Kantak; P Lewallen; W Lewis; E Lewit; C J McCarroll; D Mujsce; N R Payne; P Shiono; R F Soll; K Leahy; J H Carpenter Journal: Pediatrics Date: 2001-01 Impact factor: 7.124
Authors: Rebecca B Russell; Nancy S Green; Claudia A Steiner; Susan Meikle; Jennifer L Howse; Karalee Poschman; Todd Dias; Lisa Potetz; Michael J Davidoff; Karla Damus; Joann R Petrini Journal: Pediatrics Date: 2007-07 Impact factor: 7.124
Authors: Rolf F Maier; Béatrice Blondel; Aurélie Piedvache; Bjoern Misselwitz; Stavros Petrou; Patrick Van Reempts; Francesco Franco; Henrique Barros; Janusz Gadzinowski; Klaus Boerch; Arno van Heijst; Elizabeth S Draper; Jennifer Zeitlin Journal: Pediatr Crit Care Med Date: 2018-12 Impact factor: 3.624