Pediatric Length of Stay Guidelines and Routine Practice
The Case of Milliman and Robertson
Jeffrey S. Harman, PhD;
Kelly J. Kelleher, MD, MPH
Arch Pediatr Adolesc Med. 2001;155:885-890.
Background Guidelines for inpatient length of stay (LOS) have been developed by
Milliman and Robertson (M&R) and are widely applied by health plans. This
study was designed to compare LOS for several pediatric conditions with the
M&R LOS criteria using recent data and to determine if concordance of
actual practice with M&R LOS criteria varied between children and adults.
Design Administrative data from Pennsylvania hospitals from 1996 through 1998
were used to examine LOS for hospital discharges for 12 selected diagnoses
for which M&R published guidelines for children and adults.
Patients Discharge data for all patients discharged from public and private hospitals
in Pennsylvania for which 1 of 12 selected diagnoses were examined.
Main Outcome Measure Length of stay.
Results In Pennsylvania hospitals from 1996 through 1998, pediatric LOS was
divergent for all conditions examined, although not to the extent found in
a previous study examining data from New York State. Of note, median LOS for
some conditions was shorter than M&R LOS criteria. The percentage of pediatric
hospital discharges that exceeded the M&R LOS criteria ranged from 25%
for pneumonia to 84% for meningitis. Adult hospital discharges exceeded M&R
LOS criteria to a greater extent than did pediatric discharges for all conditions
except for sickle cell crisis and meningitis.
Conclusions The M&R LOS criteria were divergent from routine practice for both
children and adults. Greater divergence of adult discharges illustrates the
need to consider comorbid conditions when implementing these guidelines. Thus,
patient care may suffer if guidelines are implemented in an uninformed way.
These findings emphasize the importance of using the best possible science
when producing guidelines such as these.
From the Child Services Research and Development Program, University
of Pittsburgh School of Medicine, Pittsburgh, Pa.
Corresponding author and reprints: Jeffrey S. Harman, PhD, University
of Pittsburgh School of Medicine, 3811 O'Hara St, Suite 430, Pittsburgh, PA
15213 (e-mail: harmanjs{at}msx.upmc.edu).
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