Identification of potentially avoidable pediatric hospital use: Admitting physician judgment as a complement to utilization review

J. L. Soulen, Anne K Duggan, C. D. DeAngelis

Research output: Contribution to journalArticle

Abstract

Objective. To determine, for acute general pediatric admissions, 1) the proportion of admissions that the admitting physician would identify as potentially avoidable; 2) services that might help reduce avoidable admissions; 3) potential savings in hospital days through eliminating avoidable admissions; 4) the role that social factors play in admission decisions; and 5) if admitting physician judgment provides a valuable complement to Utilization Review (UR) in identifying avoidable admissions. Methods. A questionnaire was used to determine the proportion of 600 acute general pediatric admissions considered potentially avoidable by the admitting physician and to identify services required to prevent such admissions. Savings through eliminating potentially avoidable admissions and social factors influencing admission decisions were examined. Physicians' and UR assessments of necessity of inpatient care were compared. Results. Admitting physicians judged 28% of admissions as potentially avoidable, citing alternative services for each avoidable admission. Eliminating all avoidable admissions would have reduced hospital days by 7.7%. Physicians identified 6% of admissions as social admissions, most commonly due to an overwhelmed family. UR identified 1% of potentially avoidable admissions as unnecessary. Conclusion. Incorporating admitting physician judgment may significantly improve current efforts to identify and reduce avoidable hospital use.

Original languageEnglish (US)
Pages (from-to)421-424
Number of pages4
JournalPediatrics
Volume94
Issue number4 I
Publication statusPublished - 1994
Externally publishedYes

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Keywords

  • hospital use
  • physician decision making
  • physician practice patterns
  • utilization review

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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