Reducing readmissions following paediatric cardiothoracic surgery: a quality improvement initiative

Area of Science:

• Pediatric Cardiothoracic Surgery
• Health Services Research
• Quality Improvement

Background:

• Previous research identified Hispanic ethnicity, failure to thrive, and prolonged hospital stay (>10 days) as readmission risk factors after congenital heart surgery.
• Quality improvement initiatives were implemented, including interpreter use, pre-discharge medication delivery, and post-discharge follow-up calls.
• These changes aimed to mitigate identified risk factors and reduce hospital readmissions.

Purpose of the Study:

• To evaluate the impact of revised discharge processes on readmission rates following pediatric cardiothoracic surgery.
• To identify current risk factors for readmission in a contemporary cohort of patients.

Main Methods:

• A cohort of 635 patients undergoing surgery in 2012 was analyzed.
• Demographic, preoperative, operative, and postoperative variables were assessed.
• Univariate and multivariate analyses compared the 2012 cohort with an initial 2009 cohort, examining readmission rates and risk factors.

Main Results:

• The overall readmission rate remained similar between 2009 (10%) and 2012 (12%, p=0.27).
• Multivariate analysis identified congenital heart surgery score and initial hospital stay >10 days as significant risk factors for readmission.
• No statistically significant decreases in readmissions were observed for patients with Hispanic ethnicity, failure to thrive, or prolonged initial hospital stays.

Conclusions:

• Despite targeted discharge process modifications, readmission rates following pediatric cardiothoracic surgery did not significantly decrease.
• Congenital heart surgery score and initial hospital stay >10 days remain key risk factors.
• Further research is necessary to identify and implement modifiable interventions to reduce the impact of hospital readmissions.