Lenient discharge criteria and hospital readmissions for pediatric palatoplasty patients

S. M. DiMauro, Craig W Senders

Research output: Contribution to journalArticle

Abstract

Purpose: This study sought to determine whether discharge criteria which were lenient relative to current criteria would lead to a high incidence of hospital readmissions for our pediatric palatoplasty patients. Methods: This retrospective study examined the records of 45 children under the age of 48 months who were without developmental delay or any associated syndrome and who underwent the primary repair of their cleft palate between 1989 and 1996 at the University of California-Davis Medical Center. Each child was hypothetically discharged from the hospital when he or she first satisfied all of 3 lenient discharge criteria (LDC), which were: (1) a postoperative oral intake equal to at least 100% of each child's 1-hour maintenance volume (MV), (2) no concurrent fever, and (3) no concurrent airway distress. The LDC were formulated from our current discharge criteria, which are: (1) a postoperative oral intake meeting 60% of each child's 24-hour MV, (2) no fever for the 2 contiguous 8-hour nursing shifts prior to the shift of discharge, and (3) no concurrent airway distress. Each child's remaining hospital course subsequent to hypothetical discharge was reviewed for readmission criteria (RAC), which were any of the following: (1) fever, (2) airway distress, or (3) an oral intake over the 24 hours after hypothetical discharge which amounted to less than 50% of the child's 24-hour MV. Each child's 24-hour MV was calculated as 100 ml/kg for the first 10 kg of body weight, 50 ml/kg for the second 10 kg, and 25 ml/kg for each kilogram thereafter. The 1-hour MV was 1/24th the value of the 24-hour MV. Results: Twenty-seven percent of the children met RAC after being hypothetically discharged according to the LDC. Fifty-eight percent of these children developed a fever after hypothetical discharge, and the remaining 42% experienced insufficient oral intake. Seventy-three percent of the children did not meet any of the RAC. For these children, an average of 2.0 eight-hour nursing shifts was conserved by utilizing the LDC. Conclusion: The discussed LDC were proposed in an effort to benefit pediatric palatoplasty patients and their families by shortening distressing hospital stays and limiting unnecessary health-care costs. However, our results demonstrate an unacceptably high incidence of readmissions (27%) associated with these LDC. Although the discussed LDC should be avoided, inquiry into other LDC may realize benefits for the pediatric palatoplasty population.

Original languageEnglish (US)
JournalJournal of Investigative Medicine
Volume47
Issue number2
StatePublished - Feb 1999

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Patient Readmission
Pediatrics
Maintenance
Nursing
Fever
Health care
Repair
Incidence
Cleft Palate
Health Care Costs
Length of Stay
Costs
Retrospective Studies
Body Weight

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)

Cite this

Lenient discharge criteria and hospital readmissions for pediatric palatoplasty patients. / DiMauro, S. M.; Senders, Craig W.

In: Journal of Investigative Medicine, Vol. 47, No. 2, 02.1999.

Research output: Contribution to journalArticle

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abstract = "Purpose: This study sought to determine whether discharge criteria which were lenient relative to current criteria would lead to a high incidence of hospital readmissions for our pediatric palatoplasty patients. Methods: This retrospective study examined the records of 45 children under the age of 48 months who were without developmental delay or any associated syndrome and who underwent the primary repair of their cleft palate between 1989 and 1996 at the University of California-Davis Medical Center. Each child was hypothetically discharged from the hospital when he or she first satisfied all of 3 lenient discharge criteria (LDC), which were: (1) a postoperative oral intake equal to at least 100{\%} of each child's 1-hour maintenance volume (MV), (2) no concurrent fever, and (3) no concurrent airway distress. The LDC were formulated from our current discharge criteria, which are: (1) a postoperative oral intake meeting 60{\%} of each child's 24-hour MV, (2) no fever for the 2 contiguous 8-hour nursing shifts prior to the shift of discharge, and (3) no concurrent airway distress. Each child's remaining hospital course subsequent to hypothetical discharge was reviewed for readmission criteria (RAC), which were any of the following: (1) fever, (2) airway distress, or (3) an oral intake over the 24 hours after hypothetical discharge which amounted to less than 50{\%} of the child's 24-hour MV. Each child's 24-hour MV was calculated as 100 ml/kg for the first 10 kg of body weight, 50 ml/kg for the second 10 kg, and 25 ml/kg for each kilogram thereafter. The 1-hour MV was 1/24th the value of the 24-hour MV. Results: Twenty-seven percent of the children met RAC after being hypothetically discharged according to the LDC. Fifty-eight percent of these children developed a fever after hypothetical discharge, and the remaining 42{\%} experienced insufficient oral intake. Seventy-three percent of the children did not meet any of the RAC. For these children, an average of 2.0 eight-hour nursing shifts was conserved by utilizing the LDC. Conclusion: The discussed LDC were proposed in an effort to benefit pediatric palatoplasty patients and their families by shortening distressing hospital stays and limiting unnecessary health-care costs. However, our results demonstrate an unacceptably high incidence of readmissions (27{\%}) associated with these LDC. Although the discussed LDC should be avoided, inquiry into other LDC may realize benefits for the pediatric palatoplasty population.",
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AB - Purpose: This study sought to determine whether discharge criteria which were lenient relative to current criteria would lead to a high incidence of hospital readmissions for our pediatric palatoplasty patients. Methods: This retrospective study examined the records of 45 children under the age of 48 months who were without developmental delay or any associated syndrome and who underwent the primary repair of their cleft palate between 1989 and 1996 at the University of California-Davis Medical Center. Each child was hypothetically discharged from the hospital when he or she first satisfied all of 3 lenient discharge criteria (LDC), which were: (1) a postoperative oral intake equal to at least 100% of each child's 1-hour maintenance volume (MV), (2) no concurrent fever, and (3) no concurrent airway distress. The LDC were formulated from our current discharge criteria, which are: (1) a postoperative oral intake meeting 60% of each child's 24-hour MV, (2) no fever for the 2 contiguous 8-hour nursing shifts prior to the shift of discharge, and (3) no concurrent airway distress. Each child's remaining hospital course subsequent to hypothetical discharge was reviewed for readmission criteria (RAC), which were any of the following: (1) fever, (2) airway distress, or (3) an oral intake over the 24 hours after hypothetical discharge which amounted to less than 50% of the child's 24-hour MV. Each child's 24-hour MV was calculated as 100 ml/kg for the first 10 kg of body weight, 50 ml/kg for the second 10 kg, and 25 ml/kg for each kilogram thereafter. The 1-hour MV was 1/24th the value of the 24-hour MV. Results: Twenty-seven percent of the children met RAC after being hypothetically discharged according to the LDC. Fifty-eight percent of these children developed a fever after hypothetical discharge, and the remaining 42% experienced insufficient oral intake. Seventy-three percent of the children did not meet any of the RAC. For these children, an average of 2.0 eight-hour nursing shifts was conserved by utilizing the LDC. Conclusion: The discussed LDC were proposed in an effort to benefit pediatric palatoplasty patients and their families by shortening distressing hospital stays and limiting unnecessary health-care costs. However, our results demonstrate an unacceptably high incidence of readmissions (27%) associated with these LDC. Although the discussed LDC should be avoided, inquiry into other LDC may realize benefits for the pediatric palatoplasty population.

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