title: Resource utilization of pediatric patients exposed to venom.
abstract: OBJECTIVE
  Treating envenomation with antivenom is costly. Many patients being treated with antivenom are in observation status, a billing designation for patients considered to need care that is less resource-intensive, and less expensive, than inpatient care. Observation status is also associated with lower hospital reimbursements and higher patient cost-sharing. The goal of this study was to examine resource utilization for treatment of envenomation under observation and inpatient status, and to compare patients in observation status receiving antivenom with all other patients in observation status.
  
  
  METHODS
  This was a retrospective study of patients with a primary diagnosis of toxic effect of venom seen during 2009 at 33 freestanding children's hospitals in the Pediatric Health Information System. Data on age, length of stay, adjusted costs (ratio cost to charges), ICU flags, and antivenom utilization were collected. Comparisons were conducted according to admission status (emergency department only, observation status, and inpatient status), and between patients in observation status receiving antivenom and patients in observation status with other diagnoses.
  
  
  RESULTS
  A total of 2755 patients had a primary diagnosis of toxic effect of venom. Of the 335 hospitalized, either under observation (n = 124) or inpatient (n = 211) status, 107 (31.9%) received antivenom. Of those hospitalized patients receiving antivenom, 24 (22.4%) were designated as observation status. Costs were substantially higher for patients who received antivenom and were driven by pharmacy costs (mean cost: $17 665 for observation status, $20 503 for inpatient status). Mean costs for the 47 162 patients in observation status with other diagnoses were $3001 compared with $17 665 for observation-status patients who received antivenom.
  
  
  CONCLUSIONS
  Treatment of envenomation with antivenom represents a high-cost outlier within observation-status hospitalizations. Observation status can have financial consequences for hospitals and patients.
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Aneesha
authors.initials: A
authors.lastname: Narra
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Erina
authors.initials: E
authors.lastname: Lie
authors.affiliation: Children's Hospital Association, Overland Park, Kansas.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hall
authors.affiliation: C.S. Mott Children's Hospital, University of Michigan School of Medicine, Ann Arbor, Michigan.
authors.forename: Michelle
authors.initials: M
authors.lastname: Macy
authors.affiliation: Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Alpern
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and.
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Osterhoudt
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania fieldston@email.chop.edu.
authors.forename: Evan
authors.initials: E
authors.lastname: Fieldston
mesh_terms: D000553:Ambulatory Care / Q000191:economics; D000997:Antivenins / Q000627:therapeutic use; D002648:Child; D017047:Cost Sharing; D004636:Emergency Service, Hospital / Q000191:economics*; D006295:Health Resources / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics*; D006776:Hospitals, Pediatric / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics; D012189:Retrospective Studies; D012909:Snake Bites / Q000188:drug therapy / Q000191:economics*; D014481:United States
chemical_list: D000997:Antivenins
keywords: billing; envenomation; observation status; pediatrics; reimbursements; resource utilization