P360 Prolonged admissions in paediatrics – the reality of a portuguese central hospital

Introduction A Diagnosis Related Groups is a patient classification system that standardizes prospective payment to hospitals considering the main and secondary diagnoses, surgical procedures, complications, patient’s age and sex and discharge status. There are hospitalizations of normal duration, short admissions, long-term admissions and prolonged admissions according to the episode whose hospitalization time is the expected, lower, upper or greater than the maximum threshold of the respective defined hospitalization time, respectively. The objective of this study was to determine the incidence and the reasons for prolonged admissions. Methods Retrospective review of medical records of patients admitted on Department of Paediatrics and analysis of the cases classified as prolonged admissions, during the year 2017. Results There were 1493 hospitalized children with encounter for antineoplastic chemotherapy, fever and hypoxemia as the three most coded diagnoses; 1240 (83%) admissions had a normal length of stay, 177 (11.9%) were short admissions, 48 (3.2%) long-term admissions and 28 (1.9%) had prolonged evolution. In this latter group, 57% were female, the mean age was 3 years old, and the length of stay was 27 days (7–127 days), on average. Fifteen patients came from the neonatal intensive care unit, five from the outpatient clinic, two from the emergency department, and the others from other paediatric units; 53.5% of patients had a chronic pathology, and 25% had already been hospitalized in the same hospital. During the admissions in the study, 7 (25%) patients had devices, 18 (64.3%) had some complications (77.8% had an infection), 6 (21.4%) underwent invasive techniques and 3 (10.7%) were hospitalized to resolve the social situation. Liveborn infant delivered vaginally and by caesarean and symptomatic epilepsy/epileptic syndromes with complex partial seizures were the most prevalent diagnoses in this group and each episode had four additional diagnoses, on average. Discussion Most patients of this study with prolonged hospitalizations are complex, which is expected in a central hospital, requires a differentiated team and seems to justify the longer duration of hospitalization. Other studies reported that hospitalizations of children with medical complexity have lengths of stays that are typically longer than those for children without medical complexity. In this study, no comparative studies were possible due to the lack of similar patients with normal length hospitalizations, prospective studies were necessary.