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Acad Pediatr. 2018 Nov 8. pii: S1876-2859(18)30748-4. doi: 10.1016/j.acap.2018.11.002. [Epub ahead of print]

Admit v. Discharge-A Cost Analysis of Infants 29-60 Days Old with Febrile Urinary Tract Infection at Low Risk for Bacteremia.

Author information

1
Department of Emergency Medicine, Children's National Health System, George Washington University School of Medicine and Health Sciences, 111 Michigan Ave NW, Washington, DC 20010. Electronic address: astrid.butts@gmail.com.
2
Economics Department, George Mason University, 4400 University Dr, Fairfax, VA 22030. Electronic address: rsarvis@gmail.com.
3
Division of Pediatric Emergency Medicine, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110. Electronic address: schnadower_d@wustl.edu.
4
Department of Emergency Medicine, Children's National Health System, George Washington University School of Medicine and Health Sciences, 111 Michigan Ave NW, Washington, DC 20010. Electronic address: jchamber@childrensnational.org.
5
Department of Emergency Medicine, Children's National Health System, George Washington University School of Medicine and Health Sciences, 111 Michigan Ave NW, Washington, DC 20010. Electronic address: davidmathison@hotmail.com.

Abstract

BACKGROUND AND OBJECTIVES:

Ninety percent of infants 29-60 days old presenting to the emergency department (ED) with fever and urinary tract infection are admitted due to fear of concomitant bacteremia. Many of these infants are at low risk for bacteremia and can be safely discharged with no heightened risk of adverse events. This study sought to estimate the potential savings from outpatient management of low-risk infants.

METHODS:

A comparative cost analysis was performed using bacteremia probability estimates from a previously published prediction model. We estimated costs using a national pediatric database coupled with retrospective chart review of infants who presented to our ED between 2011-2015.

RESULTS:

The relative cost savings for the discharge strategy was $80,333 ($19,127 vs. $99,460; 80% savings) for each patient with bacteremia and $257,073 per 100 patients overall. Similar savings were found for charges-$304,949 ($71,421 vs $376,371; 80%) for each patient with bacteremia and $975,838 per 100 patients. Our institutional reimbursements provided an estimated savings of $148,924 ($73,280 vs. $222,204; 67%) and $476,533 per 100 patients overall.

CONCLUSIONS:

The relative cost savings from discharging rather than admitting low-risk infants with febrile UTI were significant, even accounting for expenditures associated with the return emergency room visit of initially discharged bacteremic patients. These savings are achievable without an increase in adverse events. Similar outcomes were demonstrated for hospital charges and reimbursements, which further strengthens these results. This study emphasizes how risk stratification in clinical decision-making can lead to substantial cost savings without compromising patient outcomes.

PMID:
30415079
DOI:
10.1016/j.acap.2018.11.002

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