Relationship Between Length of Stay and Patient Experience in a Pediatric Urgent Care Setting

Background: Previous studies have shown a correlation between length of stay (LOS) and patient experience scores. Patient expectations and perceived quality of care has not been studied in the pediatric urgent care (PUC) setting.

Methods: Patient encounters discharged home from 3 PUC centers with an associated patient experience survey between July 2017 to [June] 2021; excluding patient encounters if left before seen, admitted, or transferred to another care setting. Primary analysis evaluated the association between the percent of positive responses (defined as 9-10 on a 0-10 scale) for overall visit rating by LOS in minutes. Secondary analyses measured the association of percent positive overall rating with the perception of timeliness (defined as a response of ‘yes, definitely’ on a 4-point Likert scale when asked if patient was seen in a timely manner). Also evaluated the association between LOS and the rate of positive perceptions of timeliness and identified the breakpoint of the proportion of “value-added time” on the overall LOS for odds of a positive rating. We defined value-added time as the time between initial assessment to the discharge order.

Results: We included 38,573 encounters with an associated patient experience survey. Median LOS decreased from 80 minutes during the first 12 months to 74 minutes in the last 12 months (p-value <0.001) (Figure 1a). Percent positive overall visit rating increased (56.5% to 76.9%, p-value <0.001) and perceived timeliness score also increased (53.1% to 71.1%, p-value <0.001) in the same time period (Figure 1a). Positive overall rating and perceived timeliness peaked at the 31-40 minute and 21-30 minute LOS category, respectively (Figure 1b). A decline in the proportion of positive experience scores was observed for each 10-minute increase in LOS, overall rating: -1.5% (p < 0.001); perceived timeliness: -2.7% (p < 0.001). Encounters with overall LOS <= 30 minutes showed increasing positive overall and timeliness ratings as the percentage of value-added time increased for encounters (Figure 2a). However, encounters with > 30 minutes LOS had an increase of positive ratings initially but plateaued after 56-60% of value-added time (Figure 2b).

Conclusion: Workflow improvements decreased overall LOS by 7.5% with an associated increase in overall rating (38.4%) and perception of timeliness (33.9%) during the study period. Increased percentage of value-added time has a limited impact on the positive perception of timeliness and overall rating of experience after 30 minutes in this PUC setting.