Stephen A Hart1, Ronn E Tanel2, Alaina K Kipps3, Amanda K Hoerst4, Margaret A Graupe4, Steven C Cassidy5, Anthony M Hlavacek6, Martha L Clabby7, Lauren B Bush8, Wenying Zhang9, Mousumi M Banerjee10, Sara K Pasquali8, Michael Gaies11, Nicolas Madsen4. 1. Division of Pediatric Cardiology, Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan. Electronic address: stephen.hart@nationwidechildrens.org. 2. Division of Pediatric Cardiology, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, California. 3. Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California. 4. Division of Pediatric Cardiology, Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, Ohio. 5. Division of Pediatric Cardiology, Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio. 6. Division of Pediatric Cardiology, Department of Pediatrics, MUSC Children's Hospital, Medical University of South Carolina, Charleston, South Carolina. 7. Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia. 8. Division of Pediatric Cardiology, Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan. 9. Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan. 10. Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan. 11. Division of Pediatric Cardiology, Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan; Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan.
Abstract
BACKGROUND: Postoperative length of stay (LOS) is an important quality metric and is known to vary widely across hospitals after congenital heart surgery. Whether this variability is explained by factors associated with the intensive care unit (ICU) or acute care unit (ACU) remains unclear. We evaluated the relationship between ICU and ACU LOS and the impact of ACU characteristics on postoperative LOS. METHODS: Hospitalizations for congenital heart surgery within the Pediatric Cardiac Critical Care Consortium (PC4) registry (August 2014 to February 2018) were included. Models were developed for ICU, ACU, and postoperative LOS by adjusting for differences in case-mix across hospitals. PC4 hospitals participating in the Pediatric Acute Care Cardiology Collaborative (PAC3) were also surveyed on ACU organizational factors and practice patterns. RESULTS: Overall, 19,674 hospitalizations across 27 hospitals were included. There was significant variation in ICU and ACU LOS. Postperative LOS appeared to be most closely related to ICU LOS; 75% (6 of 8) of hospitals with shorter than expected postoperative LOS also had shorter than expected ICU LOS. A clear relationship between postoperative and ACU LOS was not observed. Hospitals with an ACU able to provide higher-acuity care as indexed according to the PAC3 survey were more likely to have shorter postoperative LOS (P < .01). CONCLUSIONS: For hospitals that achieve shorter than expected postoperative LOS after congenital heart surgery, ICU LOS appears to be the primary driver. Higher-acuity resources in the ACU may be an important factor facilitating earlier transfer from the ICU. These data are key to informing quality improvement initiatives geared toward reducing postoperative LOS.
BACKGROUND: Postoperative length of stay (LOS) is an important quality metric and is known to vary widely across hospitals after congenital heart surgery. Whether this variability is explained by factors associated with the intensive care unit (ICU) or acute care unit (ACU) remains unclear. We evaluated the relationship between ICU and ACU LOS and the impact of ACU characteristics on postoperative LOS. METHODS: Hospitalizations for congenital heart surgery within the Pediatric Cardiac Critical Care Consortium (PC4) registry (August 2014 to February 2018) were included. Models were developed for ICU, ACU, and postoperative LOS by adjusting for differences in case-mix across hospitals. PC4 hospitals participating in the Pediatric Acute Care Cardiology Collaborative (PAC3) were also surveyed on ACU organizational factors and practice patterns. RESULTS: Overall, 19,674 hospitalizations across 27 hospitals were included. There was significant variation in ICU and ACU LOS. Postperative LOS appeared to be most closely related to ICU LOS; 75% (6 of 8) of hospitals with shorter than expected postoperative LOS also had shorter than expected ICU LOS. A clear relationship between postoperative and ACU LOS was not observed. Hospitals with an ACU able to provide higher-acuity care as indexed according to the PAC3 survey were more likely to have shorter postoperative LOS (P < .01). CONCLUSIONS: For hospitals that achieve shorter than expected postoperative LOS after congenital heart surgery, ICU LOS appears to be the primary driver. Higher-acuity resources in the ACU may be an important factor facilitating earlier transfer from the ICU. These data are key to informing quality improvement initiatives geared toward reducing postoperative LOS.
Authors: Philip A Verhoef; Sujatha Kannan; Jamie L Sturgill; Elizabeth W Tucker; Peter E Morris; Andrew C Miller; Travis R Sexton; Jay L Koyner; Rana Hejal; Scott C Brakenridge; Lyle L Moldawer; Richard S Hotchkiss; Teresa M Blood; Monty B Mazer; Scott Bolesta; Sheila A Alexander; Donna Lee Armaignac; Steven L Shein; Christopher Jones; Caroline D Hoemann; Allan Doctor; Stuart H Friess; Robert I Parker; Alexandre T Rotta; Kenneth E Remy Journal: Crit Care Explor Date: 2021-03-12
Authors: Ashraf S Harahsheh; Alaina K Kipps; Stephen A Hart; Steven C Cassidy; Martha L Clabby; Anthony M Hlavacek; Amanda K Hoerst; Margaret A Graupe; Nicolas L Madsen; Adnan M Bakar; Erica L Del Grippo; Sonali S Patel; James E Bost; Ronn E Tanel Journal: Pediatr Cardiol Date: 2021-04-04 Impact factor: 1.655