P0317 / #1844: PREDICTORS AND DIRECT COST ESTIMATION OF EXTENDED LENGTH OF STAY IN PEDIATRIC INTENSIVE CARE UNITS IN SAUDI ARABIA: A MIXED METHODS STUDY

Abstract

Aims & Objectives: To identify predictors of extended length of stay (LOS) via identifying long-stay-patients (LSPs) in various pediatric intensive care units (PICUs) and pediatric cardiac intensive care units (PCICUs), and estimate their associated direct costs in the city of Riyadh, Saudi Arabia. Methods: This was a multicenter mixed methods study of PICUs/PCICUs patients hospitalized for ≥21 days. Ten PICUs/PCICUs leaders representing 10 tertiary hospitals in Riyadh were invited to participate in qualitative interviews using a semi-structured guide. Inductive directed content analysis was used to analyze the qualitative data. The direct medical costs were estimated for hospitalized patients in 2014 using micro-costing method and compared to another scenario if a new proposed policy of transferring LSPs from PICUs/PCICUs after 60 days of admission to step down units (SDUs) is implemented. Results: Ten PICUs/PCICUs leaders from 10 tertiary health centers participated in the study. The prevalence of LSPs decreased from 31% to 23.5% over 5 years. The acceptance and transfer of patients, measures for quality improvement, family engagement and genetic disease confirmation, approach to treatment, and medical decisions were the extracted themes believed to be associated with shorter LOS. The median cost of hospitalization per patient for the 48 identified LSPs was estimated to be SAR 623,833.57 (USD 166,355.62). However, this cost can be decreased by a median of SAR 109,675 per patient (USD 29,246.67) if the new policy was adopted. Conclusions: Implementing strategies aimed at reducing the LOS for LSPs in PICUs/PCICUs is crucial to improve spending efficiency and ICU bed availability.