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Reducing pediatric psychiatric hospital readmissions and improving quality care through an innovative Readmission
Helen Ramsbottom1, Lisa Collier Farmer1
1Department of Psychiatry, Cook Children's Medical Center, Fort Worth, Texas.
Insights
A new tool significantly reduced pediatric psychiatric readmissions. The Readmit Predictor Tool (RPT) and nurse case management decreased readmissions by nearly 30% in the first year.
Area of Science:
- Pediatric healthcare quality improvement
- Evidence-based practice in nursing
- Psychiatric readmission reduction strategies
Background:
- Less than 30-day readmissions are a significant national healthcare concern.
- Mood Disorder, not otherwise specified, was identified as a leading cause of pediatric readmissions.
- Reimbursement implications from All-Patient-Refined-Diagnostic-Related Groups necessitated addressing pediatric readmissions.
Purpose of the Study:
- To implement a strategy to reduce less than 30-day readmissions for pediatric psychiatric patients.
- To identify children at risk for readmission and provide targeted interventions.
- To improve the quality of care for pediatric patients with mood disorders.
Main Methods:
- The Iowa Model was used to guide evidence-based practice for case management.
- The Readmit Predictor Tool (RPT) and Protocol were developed to assess readmission risk.
- Nurse case managers provided follow-up calls to high-risk patients' caregivers.
Main Results:
- Readmissions decreased by 29.5% in the first year after RPT implementation.
- Further reductions of 7.8% and 5.1% were observed in the second and third years.
- These improvements occurred despite an increase in patient acuity.
Conclusions:
- The implementation of the RPT and a dedicated psychiatry nurse case manager role effectively reduced less than 30-day readmissions.
- This evidence-based approach improved patient outcomes and addressed financial concerns related to readmissions.
Problem:
Less than 30-day readmission has become a national problem. This pediatric medical center discovered that the primary diagnosis of Mood Disorder, not otherwise specified, was the third most common readmission diagnosis hospital-wide. Administration actively sought a resolution to less-than-30-day readmissions because All-Patient-Refined-Diagnostic-Related Groups would soon include pediatric hospitals with reimbursement impact.
Methods:
The Iowa Model for evidence-based practice framed the work of case management to identify readmission risk, reduce readmissions, and improve patient quality. In July 2014, the Readmit Predictor Tool (RPT) and Protocol were developed from literature review of contributing factors of pediatric psychiatric readmissions and assessed levels of readmission risk. The nurse case manager provided follow-up telephone calls to caregivers with children identified as moderate-to-high risk for readmissions.
Findings:
Effects of RPT use resulted in decreased readmissions by 29.5% in the first year, followed by 7.8% and 5.1% reductions in the second and third years, respectively, despite substantial increases in patient acuity during the period.
Conclusion:
Using the RPT and initiating the psychiatry nurse case manager position, less-than-30-day readmissions decreased over a 3-year period.
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