Hospital Costs and Charges of Discharge Delays in Children Hospitalized for Abuse and Neglect

OBJECTIVES: Hospitalizations for child maltreatment cases are longer and costlier than hospitalizations for medically similar nonabuse cases. Some discharges are delayed despite medical clearance because of a lack of safe disposition, increasing the cost of hospitalization. We aim to quantify the additional charges and costs of these delays. METHODS: A retrospective chart review evaluated the dates of medical clearance and clinical characteristics of child protection team inpatient consults from 2012 to 2014 at a 595-bed quaternary-care urban hospital. Charges and costs were compared between those with no delay, those with any delay, and those with a delay >1 day. We excluded children who were not admitted, in whom no abuse was suspected, or in whom sexual abuse was suspected absent extragenital injury. RESULTS: Thirty-six percent (134 of 375) of children hospitalized for abuse remained hospitalized after medical clearance and 20.5% (77 of 375) of children were delayed >1 day. Among those who were delayed, the mean number of days delayed was 4.37 (SD ±7.44). Mean charges after medical clearance were $13 647.53 (±$30 172.17), and mean costs after medical clearance were $6521.93 (±$13 975.34). Both charges and costs were markedly right-skewed. Median costs after medical clearance were $1553.64 (interquartile range, $26.10-$5244.20). Cumulatively, 586 total days of delay resulted in excess charges of $1.8 million. CONCLUSIONS: Continued hospitalization beyond medical clearance occurs often and represents a significant cost. Further study is needed to evaluate whether interventions can be targeted at children with characteristics correlated with prolonged discharge delays.