Pediatric Milliman and Robertson length-of-stay criteria: Are they realistic?

Marion R. Sills, Zhihuan J. Huang, Cheng Shao, Mark F. Guagliardo, James M. Chamberlain, Jill G Joseph

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Objective. Guidelines for inpatient length of stay (LOS) have been developed by several groups; among the most widely applied are those published by Milliman and Robertson (MandR). Few published reports have examined the relationship of actual practice to such guidelines, none in pediatric populations. This study was designed to compare pediatric practice in a large and defined population to M and R LOS criteria. Methods. Administrative data from New York State in 1995 were used to examine LOS for discharges corresponding to 16 selected pediatric diagnoses for which MandR publishes guidelines. Outliers, defined as the 2% of discharges with the longest LOS, were eliminated. The distribution of LOS for each diagnosis was compared with MandR LOS guidelines. Results. In New York State during 1995, pediatric LOS was markedly divergent from MandR guidelines. In general, the percentage of discharges in excess of the criterion LOS was less for nonmandatory admissions (croup: 23%, gastroenteritis: 44%, and pneumonia: 48%) than for those requiring surgery (uncomplicated appendectomy: 67%, pyloromyotomy: 62%, and major but noncritical bums: 64%) or prolonged treatment with antibiotics (bacterial meningitis: 91% and osteomyelitis: 86%). Conclusions. In New York State during 1995, LOS for selected pediatric conditions was generally in excess of published MandR guidelines. This raises concern about the potential effects of such guidelines on both patients and the hospitals caring for them. While endorsing the need for cost-effective practice, we call attention to the methods used to develop and validate guidelines.

Original languageEnglish (US)
Pages (from-to)733-737
Number of pages5
Issue number4 I
StatePublished - Apr 2000
Externally publishedYes


  • Administrative data
  • Length of stay
  • Managed health care
  • Pediatrics
  • Practice guidelines

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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