Impact of restructuring an inpatient pediatric service on length of stay and patient flow.

Objectives: To determine the impact of implementing a new pediatric inpatient structure - the clinical teaching unit (CTU) - on length of stay (LOS) and other patient care outcomes.

Methods: A retrospective study was carried out on children admitted to the General Pediatric Inpatient Service at King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia, between July 2015 and December 2018. The main outcome measures were median and mean LOS before and after CTU implementation. Other outcomes measured were the proportion of patients discharged on weekends, during daytime, and within 24 hours of admission, and the proportion of patients readmitted within 7 days of discharge.

Results: Median LOS decreased from 2.80 to 2.63 days after CTU implementation (<0.0001). The proportion of weekend discharges significantly increased after CTU implementation from 18% to 21.5% (<0.0243) and daytime discharges significantly increased from 6.9% to 25.6% (<0.0001) after CTU implementation. The improvements in LOS were sustained in the years after CTU implementation, with median LOS decreasing from 2.71 to 2.60 days during 2016-2018 (<0.001) and mean LOS decreasing from 5.03 to 3.92 days (=0.0031). During the same period, readmission rates remained stable at 3.5-4%.

Conclusion: The implementation of a new pediatric inpatient team structure led to significant improvements in many patient care outcomes, including decreased LOS.