Use of a prospectively measured incidence rate of nosocomial diarrhea in an infant/toddler ward as a meaningful quality assessment tool.

OBJECTIVE: To determine the incidence of nosocomial diarrhea as a quality assessment tool, to compare such a rate with a standard rate based on results reported in the literature, and to estimate the hospital cost of narrowing the gap between both. METHODS: This was a prospective hospital-based surveillance study of patients in a 16-cradle ward of a 316-bed public-owned children's hospital in Buenos Aires, Argentina. One hundred six pediatric patients were enrolled during the 3-month surveillance period. Data were collected by a non-attending physician under the usual conditions of care. The clinical staff members were blinded to the objectives of the investigation. RESULTS: The detected incidence rate was 22.6 episodes of nosocomial diarrhea per 100 admissions. This was 6.4-fold higher than the standard rate. Each day of nosocomial diarrhea lengthened the duration of hospitalization and thereby increased the total hospital bill of each patient. The potential savings from narrowing the gap between both rates was as much as $302,400 per year. CONCLUSIONS: Nosocomial diarrhea stands out as a relevant target both for quality improvement opportunity assessment and for cost-containment-oriented efforts.