The Resource Use Inflection Point for Safe NICU Discharge
| Autor: | Loren Berman, Cary Thurm, Matthew Hall, Sandra E. Juul, Adam B. Goldin, Mehul V. Raval, Zeenia Billimoria |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Quality management medicine.medical_treatment MEDLINE Home Care Services Hospital-Based Extracorporeal Membrane Oxygenation Intensive Care Units Neonatal Health care medicine Extracorporeal membrane oxygenation Opiate Substitution Treatment Humans Socioeconomic status Retrospective Studies Mechanical ventilation business.industry Nutritional Support Infant Newborn Retrospective cohort study Length of Stay Hospitals Pediatric Respiration Artificial Patient Discharge United States Infant Extremely Premature Pediatrics Perinatology and Child Health Emergency medicine Female business Infant Premature Methadone medicine.drug |
| Zdroj: | Pediatrics. 146(2) |
| ISSN: | 1098-4275 |
| Popis: | OBJECTIVES: (1) To identify a resource use inflection point (RU-IP) beyond which patients in the NICU no longer received NICU-level care, (2) to quantify variability between hospitals in patient-days beyond the RU-IP, and (3) to describe risk factors associated with reaching an RU-IP. METHODS: We evaluated infants admitted to any of the 43 NICUs over 6 years. We determined the day that each patient’s total daily standardized cost was RESULTS: Among 80 821 neonates, 80.6% reached an RU-IP. In total, there were 234 478 days after the RU-IP, representing 24.3% of the total NICU days and $483 281 268 in costs. Variability in the proportion of patients reaching an RU-IP was 33.1% to 98.7%. Extremely preterm and very preterm neonates, patients discharged with home health care services, or patients receiving mechanical ventilation, extracorporeal membrane oxygenation, or feeding support exhibited fewer days beyond the RU-IP. Conversely, receiving methadone was associated with increased days beyond the RU-IP. CONCLUSIONS: Identification of an RU-IP may allow health care systems to identify readiness for discharge from the NICU earlier and thereby save significant NICU days and health care dollars. These data reveal the need to identify best practices in NICUs that consistently discharge infants more efficiently. Once these best practices are known, they can be disseminated to offer guidance in creating quality improvement projects to provide safer and more predictable care across hospitals for patients of all socioeconomic statuses. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|