Short stay unit led by pediatric hospital medicine advanced practice providers

Abstract

AbstractBackgroundIn response to a critical pediatric bed shortage in 2022, an urgent process change was required to provide safe and timely medical care. We proposed a pilot for an advanced practice provider (APP)‐run short stay unit (SSU) for select pediatric hospital medicine (PHM) patients.ObjectiveTo compare length of stay (LOS) and cost before and after implementation of a PHM APP‐led SSU pilot at a tertiary pediatric hospital.Designs, Settings, and ParticipantsSingle‐center prospective pilot observational cohort study with historical control. Observation encounters for patients with asthma, bronchiolitis, croup, and dehydration were included.InterventionAn independent‐practice model SSU staffed by APPs on the PHM service.Main Outcome and MeasuresSSU encounters (September 1, 2022–December 1, 2022) were compared against pre‐SSU encounters (September 1, 2021–August 31, 2022). Cohorts were described with summary statistics. SSU encounters were matched against pre‐SSU encounters based on demographics and diagnosis, and the average effect of treatment was calculated. LOS was abstracted from the enterprise data warehouse and standardized unit cost from the Pediatric Health Information Systems database.ResultsThere were 1110 encounters included, 155 in the SSU cohort and 955 in the pre‐SSU cohort: 24.2% asthma, 30.8% bronchiolitis, 8.3% croup, and 36.7% dehydration. Median (interquartile range) unit LOS decreased from 21 (16–26) to 18 (10–22) h, p < .001. Cost decreased from $3593 ($3031–$4560) to $2958 ($2278–$3856), p < .001. After matching, the average treatment effect was reduction of 3.88 h (95% confidence interval [CI] 1.91–5.85) and $593 (95% CI $348–$839). There were no significant differences in 7‐day ED revisit rates.