504 - Factors Associated with Prolonged LOS in Children's Hospitals from 2018-2020

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 504
Publication Number: 504.221

Nicole Anania, Ann & Robert H. Lurie Children's Hospital of Chicago, New Lenox, IL, United States; Jay Berry, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States; Matt Hall, Children's Hospital Association, Lenexa, KS, United States

Presenting Author(s)

Nicole Anania, DO, MS, FAAP (she/her/hers)

Pediatric Hospitalist, Director Quality Improvement
Ann & Robert H. Lurie Children's Hospital of Chicago
New Lenox, Illinois, United States

Background: Long lengths of stay (LOS) in an acute hospital are costly and can create issues with bed availability. While the majority of pediatric patients have a short LOS, there is potential to reduce the number of patients who require a long LOS. Determining the impact of long LOS hospitalizations and the factors that contribute to them are essential to optimizing hospital bed capacity.

Objective: Measure the prevalence, bed impact, patient demographics and clinical characteristics associated with pediatric hospitalizations with LOS > 30 days.

Design/Methods: Retrospective cohort analysis of 2,349,463 pediatric hospitalizations (excluding neonates and mental health) for 49 children’s hospitals in 2018-2020 from the Pediatric Health Information System (PHIS). We used generalized estimating equations to assess demographic and clinical risk factors for LOS > 30 days, including the number of complex chronic conditions (CCC), an operating room procedure, and discharge disposition.

Results: Children with LOS >30 days represented 1.4% of all pediatric hospitalizations (hospital range 0.7%-3.9%) and 22% of total bed days (hospital range 11%-38%). The median LOS in days [interquartile range (IQR)] was 2 (IQR 1-3) for LOS < 30 days vs. 44 (IQR 35-65) for LOS >30 days (p< .001). Two factors that most increased the likelihood of a LOS >30 days: an operating room procedure [OR 3.8 (95% CI 3.3-4.3)] and the number of CCC [5+ CCC vs. 0 CCC: OR 195.8 (95% CI 168.6-227.3)]. Hospital disposition was also associated with long LOS. While the majority of patients were discharged home, children with a LOS >30 days were less likely to be discharged home (72.5% vs. 95.5%, p< .001). Patients discharged with home health [OR 2.31 (95% CI 1.81-2.94)], post-acute care facility [OR 3.5 (95% CI 2.9-4.3)], and in-hospital mortality [OR 4.4 (95% CI 3.9-5.0)] were all more likely to have LOS >30 days compared to those discharged home.

Conclusion(s): One-in-five bed days in children’s hospitals are due to prolonged LOS admissions. CCCs, an operating room procedure, and non-home discharge significantly increased the likelihood of LOS >30 days. Thus, children’s hospitals should focus on opportunities to reduce bed days in children with these attributes.