Pediatric Hospitals
Jean-François Bussières

A separate analysis of data from pediatric hospitals was conducted for the 2001/2002 report, since this group is generally known to have differences in drug costs, staffing and drug distribution. Table I-1 provides a selection of key indicators comparing data provided by respondents from pediatric facilities (n=7) to data submitted by all respondents (n=123). The pediatric facilities identified for this analysis had all responded to the main survey as distinct stand-alone operations.

The average of reported number of beds in 2001/2002 is only slightly lower in pediatric hospitals than in the overall group, but a difference is more evident for acute care length of stay (an average of 5.6 days in pediatric vs. 7.1 days overall). The shorter acute care length of stay is reflected in a higher drug cost/patient day in pediatric facilities ($48 vs. $31) whereas the drug costs/acute care admission are similar for both clienteles (~$220/admission). The situation is different for non acute drug costs, where interestingly, although the average of non acute drug costs per non acute inpatient day was lower for pediatric facilities than for the all respondent group, the non acute drug costs per non acute admission were higher in the pediatric group. The proportion of drug expenses by patient care area are larger in ambulatory (take home) patients in pediatric (23.8%) than in the all-respondent group (8.4%). This may be related to expensive orphan drug programs available for a small cohort of patients in pediatrics.

Respondents from pediatric hospitals reported a larger staffing on average. This is probably due to factors such as longer pharmacy opening hours (105 hours/week on average in pediatric vs 82 in the all respondent group), larger IV admixture production (1.84 admixture/acute patient days in pediatric vs 1.19 overall) and a larger proportion of unit dose systems (55% in pediatric vs 45% overall). These services create a more intensive pharmacy workload to the benefit of nursing. The difference in staffing for pediatrics versus adults may also be partially explained by the need to individualize doses based on weight/body surface area, which requires both more preparation time for drug distribution and more time spent verifying the physician’s order by clinical pharmacists.

Finally, the potential for clinical pharmacy interventions is greater or equal in pediatric populations than in adult hospitals. Although the average of reported number of interventions per pharmacist was lower in the pediatric group than in the overall group (446 vs. 568), the average of reported number of interventions per admission was higher (0.7 vs. 0.6).

A selection of respondents was approached to complete a distinct section on benchmarking, and four pediatric hospitals also completed that questionnaire. Three of these four sites are represented in the group of seven pediatric facilities discussed above; the fourth was a pediatric facility operating within a larger pharmacy department in a multi-site complex. For additional information and discussion of the benchmarking results for pediatric facilities, please refer to the section entitled “A Program Breakdown of Benchmark Indicators for Pharmacy Staffing and Drug Costs.”