LAUSR

Department of Pediatrics. Centro Materno Pediátrico, Centro Hospitalar e Universitário de São João, Oporto, Portugal Introduction and aim Level III hospitals are the last resource of health care, covering more complex patients. According to the literature, these patients are hospitalized more often and for longer. Long-term hospitalizations are defined as episodes whose hospitalization time is equal to or greater than the upper threshold of exception and lower than the maximum threshold of the DRG to which they belong. We aim to characterize long-term hospitalizations in 2017 at a Level III Hospital. Methods Retrospective analysis of long-term admissions in 2017 at a Level III Hospital, including: age, number of hospitalizations, resources at the emergency service, average length of stay, presence of chronic disease, comorbidities and pediatric appointments, through consultation of electronic processes. Results In 2017 there were 1493 hospitalized children; 1240 (83%) admissions had a normal length of stay, 177 (11.9%) were short admissions, 48 (3.2%) long-term admissions and 28 (1.9%) had prolonged evolution. We identified 49 patients with long-term hospitalizations. Of these, 33 males, mean age of 2.3 years (min 1 day, max 17 years). Most were patients with chronic pathology (65.3%), oncology (22.4%), neurology (16.3%) and neonatology (16.3%). However, patients had, on average, 4 more diagnoses associated with the main reason for admission. Fever, respiratory or gastrointestinal symptoms prolonged or precipitated hospitalizations in 41.3% of patients. Ten of these patients had central venous catheter, 4 nasogastric tube/percutaneous gastrostomy, 2 ventricular shunts. On average, these patients had 2.79 hospital admissions per year, with an average length of hospital stay of 20.1 days and 1.69 appeals to the emergency department precipitated by sub-acute conditions such as gastroenteritis or respiratory diseases, which prolonged hospitalizations. In 15% there were infections by multi-resistant microorganisms. The follow-up in multidisciplinary pediatric appointment occurred in 79.5%. Discussion Long-term admissions occurred mainly in chronically ill patients. Most, cancer or neurological patients, for decompensation of underlying disease. The percentage of patients infected with multi-resistant micro-organisms points to the need to adapt physical and medical resources to provide better care. The complexity of these patients demands the contribution of different Pediatric subspecialties and is associated with a higher mortality risk than the majority of Pediatric Services, which makes the hospitalization of our Service a reference in the provision of care in chronic pediatric illness in Portugal.