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The Timing of Neonatal Discharge: An Example of Unwarranted Variation?
Discharge from an intensive care nursery should be dependent on the infant's clinical and social condition and independent of the day of the week. To evaluate admission and discharge dates of 5272 neonates cared for in 5 major metropolitan regions in the United States and managed by a national...
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| Published in: | Pediatrics (Evanston) 2001-01, Vol.107 (1), p.73-77 |
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| creator | Touch, Suzanne M Greenspan, Jay S Kornhauser, Michael S O'Connor, John P Nash, David B Spitzer, Alan R |
| description | Discharge from an intensive care nursery should be dependent on the infant's clinical and social condition and independent of the day of the week.
To evaluate admission and discharge dates of 5272 neonates cared for in 5 major metropolitan regions in the United States and managed by a national disease management company for the distribution of the day of the week.
All infants discharged to home between July 1, 1996 and September 30, 1998 are included. Data are represented as a percentage of total discharges or admissions for each weekday assignment. Using the normal approximation to the multinomial distribution, we tested for proportional differences on each weekday.
The data demonstrate that the timing of nursery discharge has an uneven distribution across the days of the week, with weekend (Saturday and Sunday) discharge rates that are significantly lower than weekday discharge rates. This uneven distribution exists in both the term and preterm subgroups as well. There is also an uneven distribution of births among the days of the week, with a pattern that reveals fewer weekend births than weekday births in the entire population studied, as well as in both the term and preterm subgroups. Normalizing these weekend discharges to the previous weekday could generate potential saving of $1 569 405 in charges for the total population and 627 days of hospitalization. The average length of stay of infants discharged on Mondays is longer than for those infants discharged on Saturday or Sunday.
We speculate that changes in discharge planning could decrease the variation in day of discharge, shorten length of hospitalization, and potentially reduce cost. |
| doi_str_mv | 10.1542/peds.107.1.73 |
| format | article |
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To evaluate admission and discharge dates of 5272 neonates cared for in 5 major metropolitan regions in the United States and managed by a national disease management company for the distribution of the day of the week.
All infants discharged to home between July 1, 1996 and September 30, 1998 are included. Data are represented as a percentage of total discharges or admissions for each weekday assignment. Using the normal approximation to the multinomial distribution, we tested for proportional differences on each weekday.
The data demonstrate that the timing of nursery discharge has an uneven distribution across the days of the week, with weekend (Saturday and Sunday) discharge rates that are significantly lower than weekday discharge rates. This uneven distribution exists in both the term and preterm subgroups as well. There is also an uneven distribution of births among the days of the week, with a pattern that reveals fewer weekend births than weekday births in the entire population studied, as well as in both the term and preterm subgroups. Normalizing these weekend discharges to the previous weekday could generate potential saving of $1 569 405 in charges for the total population and 627 days of hospitalization. The average length of stay of infants discharged on Mondays is longer than for those infants discharged on Saturday or Sunday.
We speculate that changes in discharge planning could decrease the variation in day of discharge, shorten length of hospitalization, and potentially reduce cost.</description><identifier>ISSN: 0031-4005</identifier><identifier>EISSN: 1098-4275</identifier><identifier>DOI: 10.1542/peds.107.1.73</identifier><identifier>PMID: 11134437</identifier><identifier>CODEN: PEDIAU</identifier><language>eng</language><publisher>Elk Grove Village, IL: Am Acad Pediatrics</publisher><subject>Admission and discharge ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Babies ; Benchmarking ; Biological and medical sciences ; Care and treatment ; Cost Control ; Critical care ; Discharge ; Emergency and intensive care: neonates and children. Prematurity. Sudden death ; Hospital admission and discharge ; Hospital stays ; Hospital utilization ; Hospitalization ; Hospitals ; Humans ; Infant, Newborn ; Infants (Newborn) ; Intensive care medicine ; Intensive Care Units, Neonatal - economics ; Intensive Care Units, Neonatal - organization & administration ; Intensive Care Units, Neonatal - statistics & numerical data ; Length of stay ; Length of Stay - economics ; Medical sciences ; Newborn infants ; Patient Admission - economics ; Patient Discharge - economics ; Pediatrics ; United States</subject><ispartof>Pediatrics (Evanston), 2001-01, Vol.107 (1), p.73-77</ispartof><rights>2001 INIST-CNRS</rights><rights>COPYRIGHT 2001 American Academy of Pediatrics</rights><rights>COPYRIGHT 2001 American Academy of Pediatrics</rights><rights>Copyright American Academy of Pediatrics Jan 2001</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c527t-ade91279a004b8d7f9ef7ffd6a6349914da3f0f00f22b7ec61fb4d964dea65c3</citedby><cites>FETCH-LOGICAL-c527t-ade91279a004b8d7f9ef7ffd6a6349914da3f0f00f22b7ec61fb4d964dea65c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,4024,27923,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=884163$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11134437$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Touch, Suzanne M</creatorcontrib><creatorcontrib>Greenspan, Jay S</creatorcontrib><creatorcontrib>Kornhauser, Michael S</creatorcontrib><creatorcontrib>O'Connor, John P</creatorcontrib><creatorcontrib>Nash, David B</creatorcontrib><creatorcontrib>Spitzer, Alan R</creatorcontrib><title>The Timing of Neonatal Discharge: An Example of Unwarranted Variation?</title><title>Pediatrics (Evanston)</title><addtitle>Pediatrics</addtitle><description>Discharge from an intensive care nursery should be dependent on the infant's clinical and social condition and independent of the day of the week.
To evaluate admission and discharge dates of 5272 neonates cared for in 5 major metropolitan regions in the United States and managed by a national disease management company for the distribution of the day of the week.
All infants discharged to home between July 1, 1996 and September 30, 1998 are included. Data are represented as a percentage of total discharges or admissions for each weekday assignment. Using the normal approximation to the multinomial distribution, we tested for proportional differences on each weekday.
The data demonstrate that the timing of nursery discharge has an uneven distribution across the days of the week, with weekend (Saturday and Sunday) discharge rates that are significantly lower than weekday discharge rates. This uneven distribution exists in both the term and preterm subgroups as well. There is also an uneven distribution of births among the days of the week, with a pattern that reveals fewer weekend births than weekday births in the entire population studied, as well as in both the term and preterm subgroups. Normalizing these weekend discharges to the previous weekday could generate potential saving of $1 569 405 in charges for the total population and 627 days of hospitalization. The average length of stay of infants discharged on Mondays is longer than for those infants discharged on Saturday or Sunday.
We speculate that changes in discharge planning could decrease the variation in day of discharge, shorten length of hospitalization, and potentially reduce cost.</description><subject>Admission and discharge</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Babies</subject><subject>Benchmarking</subject><subject>Biological and medical sciences</subject><subject>Care and treatment</subject><subject>Cost Control</subject><subject>Critical care</subject><subject>Discharge</subject><subject>Emergency and intensive care: neonates and children. Prematurity. Sudden death</subject><subject>Hospital admission and discharge</subject><subject>Hospital stays</subject><subject>Hospital utilization</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>Infants (Newborn)</subject><subject>Intensive care medicine</subject><subject>Intensive Care Units, Neonatal - economics</subject><subject>Intensive Care Units, Neonatal - organization & administration</subject><subject>Intensive Care Units, Neonatal - statistics & numerical data</subject><subject>Length of stay</subject><subject>Length of Stay - economics</subject><subject>Medical sciences</subject><subject>Newborn infants</subject><subject>Patient Admission - economics</subject><subject>Patient Discharge - economics</subject><subject>Pediatrics</subject><subject>United States</subject><issn>0031-4005</issn><issn>1098-4275</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><recordid>eNpt0s9v0zAUB3ALgVgZHLmiCCTEYSl2YscJF1SVbSBV7FK4Wq_Oc-opsTs70cZ_j6tVY0OVD_6hj_y-sh8hbxmdM8GLzzts45xROWdzWT4jM0abOueFFM_JjNKS5ZxScUJexXhNKeVCFi_JCWOs5LyUM3Kx3mK2toN1XeZN9hO9gxH67JuNeguhwy_ZwmXndzDsetyLX-4WQgA3Ypv9hmBhtN59fU1eGOgjvjnMp2R9cb5efs9XV5c_lotVrkUhxxxabFghG0hJNnUrTYNGGtNWUJW8aRhvoTTUUGqKYiNRV8xseNtUvEWohC5Pycf7a3fB30wYRzWknNj34NBPUUkqhKhpneD7_-C1n4JL0VRR1JyymjUJnd2jDnpU1hk_BtAdOgzQe4fGpuNF1VQi8TLx_AhPo8XB6mP-0xOfyIh3YwdTjKq-XD2hZ8eo9n2PHar0hMurY0l08DEGNGoX7ADhj2JU7btC7bsibaRiSu79u8NrTJsB23_60AYJfDgAiBp6k_5X2_jg6pqz6lHZre22tzbgvkxqgGB1fLR8KPsXE4nMVQ</recordid><startdate>20010101</startdate><enddate>20010101</enddate><creator>Touch, Suzanne M</creator><creator>Greenspan, Jay S</creator><creator>Kornhauser, Michael S</creator><creator>O'Connor, John P</creator><creator>Nash, David B</creator><creator>Spitzer, Alan R</creator><general>Am Acad Pediatrics</general><general>American Academy of Pediatrics</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>8GL</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>20010101</creationdate><title>The Timing of Neonatal Discharge: An Example of Unwarranted Variation?</title><author>Touch, Suzanne M ; Greenspan, Jay S ; Kornhauser, Michael S ; O'Connor, John P ; Nash, David B ; Spitzer, Alan R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c527t-ade91279a004b8d7f9ef7ffd6a6349914da3f0f00f22b7ec61fb4d964dea65c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Admission and discharge</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Babies</topic><topic>Benchmarking</topic><topic>Biological and medical sciences</topic><topic>Care and treatment</topic><topic>Cost Control</topic><topic>Critical care</topic><topic>Discharge</topic><topic>Emergency and intensive care: neonates and children. Prematurity. Sudden death</topic><topic>Hospital admission and discharge</topic><topic>Hospital stays</topic><topic>Hospital utilization</topic><topic>Hospitalization</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>Infants (Newborn)</topic><topic>Intensive care medicine</topic><topic>Intensive Care Units, Neonatal - economics</topic><topic>Intensive Care Units, Neonatal - organization & administration</topic><topic>Intensive Care Units, Neonatal - statistics & numerical data</topic><topic>Length of stay</topic><topic>Length of Stay - economics</topic><topic>Medical sciences</topic><topic>Newborn infants</topic><topic>Patient Admission - economics</topic><topic>Patient Discharge - economics</topic><topic>Pediatrics</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Touch, Suzanne M</creatorcontrib><creatorcontrib>Greenspan, Jay S</creatorcontrib><creatorcontrib>Kornhauser, Michael S</creatorcontrib><creatorcontrib>O'Connor, John P</creatorcontrib><creatorcontrib>Nash, David B</creatorcontrib><creatorcontrib>Spitzer, Alan R</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: High School</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatrics (Evanston)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Touch, Suzanne M</au><au>Greenspan, Jay S</au><au>Kornhauser, Michael S</au><au>O'Connor, John P</au><au>Nash, David B</au><au>Spitzer, Alan R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Timing of Neonatal Discharge: An Example of Unwarranted Variation?</atitle><jtitle>Pediatrics (Evanston)</jtitle><addtitle>Pediatrics</addtitle><date>2001-01-01</date><risdate>2001</risdate><volume>107</volume><issue>1</issue><spage>73</spage><epage>77</epage><pages>73-77</pages><issn>0031-4005</issn><eissn>1098-4275</eissn><coden>PEDIAU</coden><abstract>Discharge from an intensive care nursery should be dependent on the infant's clinical and social condition and independent of the day of the week.
To evaluate admission and discharge dates of 5272 neonates cared for in 5 major metropolitan regions in the United States and managed by a national disease management company for the distribution of the day of the week.
All infants discharged to home between July 1, 1996 and September 30, 1998 are included. Data are represented as a percentage of total discharges or admissions for each weekday assignment. Using the normal approximation to the multinomial distribution, we tested for proportional differences on each weekday.
The data demonstrate that the timing of nursery discharge has an uneven distribution across the days of the week, with weekend (Saturday and Sunday) discharge rates that are significantly lower than weekday discharge rates. This uneven distribution exists in both the term and preterm subgroups as well. There is also an uneven distribution of births among the days of the week, with a pattern that reveals fewer weekend births than weekday births in the entire population studied, as well as in both the term and preterm subgroups. Normalizing these weekend discharges to the previous weekday could generate potential saving of $1 569 405 in charges for the total population and 627 days of hospitalization. The average length of stay of infants discharged on Mondays is longer than for those infants discharged on Saturday or Sunday.
We speculate that changes in discharge planning could decrease the variation in day of discharge, shorten length of hospitalization, and potentially reduce cost.</abstract><cop>Elk Grove Village, IL</cop><pub>Am Acad Pediatrics</pub><pmid>11134437</pmid><doi>10.1542/peds.107.1.73</doi><tpages>5</tpages></addata></record> |
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| ispartof | Pediatrics (Evanston), 2001-01, Vol.107 (1), p.73-77 |
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| source | EZB* |
| subjects | Admission and discharge Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Babies Benchmarking Biological and medical sciences Care and treatment Cost Control Critical care Discharge Emergency and intensive care: neonates and children. Prematurity. Sudden death Hospital admission and discharge Hospital stays Hospital utilization Hospitalization Hospitals Humans Infant, Newborn Infants (Newborn) Intensive care medicine Intensive Care Units, Neonatal - economics Intensive Care Units, Neonatal - organization & administration Intensive Care Units, Neonatal - statistics & numerical data Length of stay Length of Stay - economics Medical sciences Newborn infants Patient Admission - economics Patient Discharge - economics Pediatrics United States |
| title | The Timing of Neonatal Discharge: An Example of Unwarranted Variation? |
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