Reduced Hospital Charges and Length-of-stay With Continued Use of Clinical Practice Guidelines for Pelvic Inflammatory Disease.

Abstract

Background Clinical practice guidelines (CPG) were developed to promote improved, consistent care and decrease costs associated with hospitalization of adolescents for pelvic intlammatory disease (PID). This study was undertaken to evaluate the impact of continued use of the CPG for PID on hospital charges, length-of-stay, and appropriate care. Methods A CPG was initiated for the inpatient management of PID in adolescents in April 1993. Patients were admitted to the CPG if they met three minimum criteria for PID (in the absence of another established cause): lower abdominal tenderness, cervical motion tenderness, and adnexal tenderness. Time 1 was defined as April 1993 -June 1994 (CPG pilot phase) (N = 69), Time 2 as July 1994 – July 1995 (established CPG) (N = 18). Data analyzed included demographic characteristics, time to treatment, use and results of diagnostic tests, hospital charges, length-of-stay, and discharge diagnosis. Chi square tests were used for categorical variables and Fisher's exact t tests were used for continuous variables. Results Eighty-seven patients were admitted with a clinical diagnosis of PID: mean age 16.9 years (range 13–22), 69% black, 23% Hispanic, 82% English-speaking, and 45% on Medicaid. PID was the discharge diagnosis in 64 patients (74%). One-third of patients (29) had positive cultures: 17 (25%) Chlamydia trachomatis, 7 (12%) Neisseria gonorrheae, and 5 (6%) both chlamydia and gonorrhea. Laparoscopy was performed on 5 patients, revealing endometriosis (2), normal pelvis (2), and PID (1). There were no differences between the two time periods in demographics characteristics, discharge diagnoses, positive cultures, time to antibiotics, or number of laparoscopies. Pelvic ultrasounds were obtained in 45 patients (65%) in Time 1 and 6 (33%) in Time 2 (p = 0.014), with no difference in the proportion of positive readings. Mean length-of-stay was reduced from 3.8 to 2.8 days (p = 0.036) and total hospital charges from $5489 to $4081 (p = 0.034). Conclusions Continued use of a CPG during hospitalization of adolescents with uncomplicated PID can result in reduced length-of-stay and hospital charges without compromising appropriate care.