Use of Utilization Review to Assess the Quality of Pediatric Inpatient Care

Between 100 and 123 medical records of children hospitalized in each of three community hospitals and one major teaching hospital were examined to determine the need for and the quality of the care administered. Twenty-five percent of all patient days were considered unnecessary; this varied from 7% in the teaching hospital to a mean of 38% in the community hospitals. The cost of unnecessary hospital days and laboratory and x-ray studies for the 428 patients was 37, 460, or 88 per patient discharged; the means per patient discharged from the three community hospitals and the teaching hospital were 101 and 54 respectively. About one-third of all the patients received less than optimal care; this varied from 13% in the teaching hospital to 43% in the community hospitals. Misuse of antibiotics and questionable use of other drugs accounted for 79% of instances of questionable care.