The Hospital as Predictor of Children's and Adolescents' Length of Stay

Department of Psychology, Loyola University Chicago, IL 60626, USA.
Journal of the American Academy of Child & Adolescent Psychiatry (Impact Factor: 7.26). 03/2006; 45(3):322-8. DOI: 10.1097/
Source: PubMed


To predict psychiatric hospital length of stay (LOS) for a sample of Illinois Department of Children and Family Services wards across 4 fiscal years.
A prospective design was implemented using the Children's Severity of Psychiatric Illness scale, a reliable and valid measure of psychiatric severity, risk factors, youth strengths, and contextual/environmental factors. Data were collected for 1,930 hospital episodes across 44 hospitals from fiscal year 1998 through fiscal year 2001. Youths were screened for admission appropriateness by the Illinois Screening, Assessment, and Supportive Services (SASS) program. The Children's Severity of Psychiatric Illness was completed by SASS workers upon conclusion of their crisis interviews. In addition to completing the Children's Severity of Psychiatric Illness, SASS workers reported on demographic information and LOS.
The sample of 1,930 youths was randomly split to form development (n = 983) and validation (n = 947) samples. LOS was predicted using ordinary least squares regression. Thirty percent of the variance (F(19,666) = 16.6, p < .0001) in LOS was predicted for the development sample and 22% (F(14,657) = 14.6, p < .0001) was predicted for the confirmation sample. Hospital was the largest and most consistent predictor of LOS for both samples after controlling for clinical variables. Two hospitals accounted for approximately 10% of the variance in both samples (development beta = .273, p < .01 and beta = -.169, p < .01). Two SASS agencies also consistently predicted LOS (development beta = -.134, p < .05 and beta = .102, p < .05). No consistent changes in predictors of LOS occurred over time (FY98-FY01).
These findings suggest that nonclinical variables are the primary predictors of LOS in the Illinois system of care. In addition, these variables are consistent predictors over time. Quality assurance efforts might seek to further understand potential practice pattern variations across hospitals and SASS agencies.

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Available from: John S Lyons, Aug 15, 2015
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    • "Although some research suggests an association between adrenocortical function and length of hospitalization (Luebbe, Elledge, Kiel, & Stoppelbein, 2012), previous research has failed to identify consistent patient demographic or diagnostic characteristics that reliably predict length of stay (Gifford & Foster, 2008; Leon, Snowden, Bryant, & Lyons, 2006). A study by Sadeh and colleagues found lengths of stay for sexually abused children were longer than physically abused children or non-traumatized peers (1994); however, the mean length of stay for sexually abused children was 73 days compared to 43 days for nonabused patients. "
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    • "As mentioned, our large clinical sample also provided the power to detect small effects. Given the multiple contextual influences on actual behavior and the logistical and systemic factors that often impact treatment decisions (i.e., hospital discharge; Leon et al., 2006), it was unsurprising that effects were small in our study. "
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    • "Hospital was the only variable significantly associated with both initiation and change, indicating that decisions regarding psychotropic regimens may operate differently based on the organizational context of the hospital, rather than characteristics of the adolescents. The result is consistent with prior research showing connections between hospital and length of stay (Leon et al. 2006), and supports the argument that successful introduction of best practices to adolescent psychiatric services depends "
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