Published online June 2, 2008
PEDIATRICS Vol. 121 No. 6 June 2008, pp. e1653-e1659 (doi:10.1542/peds.2007-2831)
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ARTICLE

Charges and Lengths of Stay Attributable to Adverse Patient-Care Events Using Pediatric-Specific Quality Indicators: A Multicenter Study of Freestanding Children's Hospitals

Matthew P. Kronman, MDa, Matthew Hall, PhDb, Anthony D. Slonim, MD, DrPHc and Samir S. Shah, MD, MSCEa,d

a Divisions of General Pediatrics and Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
b Child Health Corporation of America, Shawnee Mission, Kansas
c Departments of Internal Medicine and Pediatrics, Carilion Clinic Children's Hospital, Roanoke, Virginia
d Departments of Pediatrics and Epidemiology and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

OBJECTIVE. The purpose of this work was to determine the excess charges, both overall and according to category, and lengths of stay attributable to adverse patient-care events during pediatric hospitalization.

METHODS. Agency for Healthcare Research and Quality pediatric-specific quality indicators were used to identify adverse events in 431524 discharges from 38 freestanding, academic, not-for-profit, tertiary care pediatric hospitals in the United States participating in the Pediatric Health Information System database in 2006. All of the discharges from any of the 38 hospitals participating in the Pediatric Health Information System between January 1 and December 31, 2006, were eligible for inclusion. The primary outcomes were excess lengths of stay and charges (both overall and according to pharmacy, laboratory, imaging, clinical, supply, and other categories) were attributable to adverse patient-safety events as determined by 12 pediatric-specific quality indicators.

RESULTS. Statistically significant excess lengths of stay attributable to pediatric-specific quality indicator events ranged from 2.8 days for accidental puncture and laceration to 23.5 days for postoperative sepsis, and statistically significant excess overall charges ranged from $34884 for accidental puncture and laceration to $337226 for in-hospital mortality after pediatric heart surgery. Each charge category had significant charge increases caused by pediatric-specific quality indicator events, with the largest being laboratory and other charges, ranging from $7622 to $78048 and $11094 to $97805, respectively.

CONCLUSIONS. Some adverse events experienced during pediatric hospitalization have the potential to increase lengths of stay and charges considerably, and pediatric-specific quality indicators are useful in calculating these effects.

Key Words: patient-safety indicators • quality indicators • safety • medical error • inpatients • pediatrics • children • administrative data

Abbreviations: AHRQ—Agency for Healthcare Research and Quality • PSI—patient-safety indicator • ICD-9-CM—International Classification of Diseases, Ninth Revision, Clinical Modification • LOS—length of stay • PDI—pediatric-specific quality indicator • PHIS—Pediatric Health Information System • APR-DRG—all-patient refined diagnosis-related group • KID—Kids' Inpatient Database

Accepted Dec 12, 2007.