Michael Lee1, Angela Bachim2, Carolyn Smith3, Elizabeth A Camp4, Marcella Donaruma-Kwoh2, Binita Patel4. 1. Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; mike.lee@alumni.duke.edu. 2. Sections of Public Health Pediatrics and. 3. Decision Support and Cost Accounting, Texas Children's Hospital, Houston, Texas. 4. Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas; and.
Abstract
OBJECTIVES: Hospitalizations for child maltreatment cases are longer and costlier than hospitalizations for medically similar nonabuse cases. Some discharges are delayed despite medical clearance because of a lack of safe disposition, increasing the cost of hospitalization. We aim to quantify the additional charges and costs of these delays. METHODS: A retrospective chart review evaluated the dates of medical clearance and clinical characteristics of child protection team inpatient consults from 2012 to 2014 at a 595-bed quaternary-care urban hospital. Charges and costs were compared between those with no delay, those with any delay, and those with a delay >1 day. We excluded children who were not admitted, in whom no abuse was suspected, or in whom sexual abuse was suspected absent extragenital injury. RESULTS: Thirty-six percent (134 of 375) of children hospitalized for abuse remained hospitalized after medical clearance and 20.5% (77 of 375) of children were delayed >1 day. Among those who were delayed, the mean number of days delayed was 4.37 (SD ±7.44). Mean charges after medical clearance were $13 647.53 (±$30 172.17), and mean costs after medical clearance were $6521.93 (±$13 975.34). Both charges and costs were markedly right-skewed. Median costs after medical clearance were $1553.64 (interquartile range, $26.10-$5244.20). Cumulatively, 586 total days of delay resulted in excess charges of $1.8 million. CONCLUSIONS: Continued hospitalization beyond medical clearance occurs often and represents a significant cost. Further study is needed to evaluate whether interventions can be targeted at children with characteristics correlated with prolonged discharge delays.
OBJECTIVES: Hospitalizations for child maltreatment cases are longer and costlier than hospitalizations for medically similar nonabuse cases. Some discharges are delayed despite medical clearance because of a lack of safe disposition, increasing the cost of hospitalization. We aim to quantify the additional charges and costs of these delays. METHODS: A retrospective chart review evaluated the dates of medical clearance and clinical characteristics of child protection team inpatient consults from 2012 to 2014 at a 595-bed quaternary-care urban hospital. Charges and costs were compared between those with no delay, those with any delay, and those with a delay >1 day. We excluded children who were not admitted, in whom no abuse was suspected, or in whom sexual abuse was suspected absent extragenital injury. RESULTS: Thirty-six percent (134 of 375) of children hospitalized for abuse remained hospitalized after medical clearance and 20.5% (77 of 375) of children were delayed >1 day. Among those who were delayed, the mean number of days delayed was 4.37 (SD ±7.44). Mean charges after medical clearance were $13 647.53 (±$30 172.17), and mean costs after medical clearance were $6521.93 (±$13 975.34). Both charges and costs were markedly right-skewed. Median costs after medical clearance were $1553.64 (interquartile range, $26.10-$5244.20). Cumulatively, 586 total days of delay resulted in excess charges of $1.8 million. CONCLUSIONS: Continued hospitalization beyond medical clearance occurs often and represents a significant cost. Further study is needed to evaluate whether interventions can be targeted at children with characteristics correlated with prolonged discharge delays.
Authors: Patrick T Delaplain; Areg Grigorian; Eugene Won; Austin R Dosch; Sebastian Schubl; Jose Covarrubias; Jeffry Nahmias Journal: Pediatr Emerg Care Date: 2021-12-01 Impact factor: 1.454