Pediatric Discharges Research Articles

A Survey of Pediatric Discharge Educational Programs in North American Burn Units

In this study we contacted all of the 149 major North American burn facilities that treat children. The survey determined topics covered in discharge teaching, personnel administering the programs, methods used, and obstacles encountered. The subjects addressed and the personnel involved have changed little from a decade ago. Unfortunately, one fourth of the centers still do not deal with emotional aspects of burns in their discharge programs. For program delivery, videotape is becoming an increasingly accepted teaching method. Eighty-five percent of burn facilities experienced barriers to patient education at discharge, with more than half reporting three or more difficulties. The most common difficulty was time constraints (50%), followed by language and sociocultural barriers (41%), lack of receptivity by clientele (39%), lack of educational materials and planning (26%), and inadequate funding (25%). Some of these problems might be alleviated by the establishment of a clearinghouse for burn educational materials.

The Development of a Discharge Planning Index for Use in a Pediatric Acute Burn Unit

The purpose of this study was to develop a discharge planning index for use in a pediatric acute burn unit. The study sample consisted of 59 health professionals from a pediatric burn hospital who had worked at least one year with children with acute burns and their families in discharge planning. With the use of the Delphi technique, a three-round survey was conducted. A Pediatric Acute Burn Discharge Planning Index that consists of 75 items was developed on the basis of the items that received a mean score of 5.0 or greater in the third survey. The data were further analyzed with Spearman's rank correlation coefficient to compare the top 23 rank-ordered items rated by the nursing department with those rated by the other departments surveyed. The rank-order correlation showed a positive correlation between the nursing department's and other departments' responses. These results indicate that all health team members agree on the importance of assessing the items listed on the derived index before discharging a pediatric patient with acute burns.

Potential economic impact of applying DRG-based prospective payment categories to inflammatory bowel disease patients

New incentives regarding delivery of inpatient care by physicians and administrators have resulted from Medicare's DRG-based prospective reimbursement system. As these payment systems become widely adopted by other third-party payors, implications for adequate hospital reimbursement and quality inpatient care will intensify. This study of inflammatory bowel disease inpatients examines discharge data for 300 patients comprising 507 admissions from 1983 to 1987 at a large tertiary center hospital. While only 10.8% of these discharges were Medicare patients, all discharges were assigned a diagnosis-related-group reimbursement to derive a theoretical monetary loss or gain for the hospital. Overall hospital losses averaged $127.24 per case for this patient population, in which the medical and pediatric cases were adequately reimbursed, and the surgical admissions represented greater losses. The average length of stay for all patients decreased from 11.9 to 7.4 days over the study period, mostly a result of reductions in surgical hospital stays. We conclude that reimbursement for medical and pediatric discharges under DRG 179 appear adequate for this hospital, while surgical inflammatory bowel disease reimbursement is not. These data will be useful for comparison of future trends of inpatient utilization for inflammatory bowel disease patients as prospective reimbursement practices become more widespread.