Pediatric Epilepsy Readmissions: The Who, When, and Why
Marissa Vawter-Lee1, Alexandria Lutley2, Sharon W Lake3
1Division of Child Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Insights
Pediatric epilepsy readmissions occur at an 8.0% rate, with 21.5% deemed preventable, often due to discharge plan or medication issues within seven days of initial hospital release.
Area of Science:
- Pediatric Neurology
- Healthcare Quality Improvement
- Hospital Readmission Studies
Background:
- Previous research indicated a 6-10% pediatric epilepsy readmission rate.
- Detailed characteristics of readmitted pediatric epilepsy patients were previously undescribed.
Purpose of the Study:
- To characterize pediatric patients readmitted within 30 days of hospital discharge for epilepsy.
- To identify factors contributing to 30-day readmissions in pediatric epilepsy cases.
Main Methods:
- An interdisciplinary team reviewed 30-day readmissions for pediatric epilepsy patients from May 2014 to October 2016.
- The team included neuroscience nurses, care managers, a quality outcomes manager, and child neurology physicians.
Main Results:
- The all-cause 30-day readmission rate was 8.0% (219 readmissions from 169 patients).
- 21.5% of readmissions were scheduled, 37% for chronic epilepsy progression, 9.6% for new epilepsy diagnoses, and 14.6% for unrelated issues.
- 21.5% of readmissions were classified as preventable, with most occurring within seven days of discharge, often due to discharge plan or medication management issues.
Conclusions:
- 21.5% of pediatric epilepsy readmissions were preventable, with a majority occurring within one week of initial discharge.
- Addressing discharge care plans and medication management is crucial for reducing preventable pediatric epilepsy readmissions.
Background:
Prior studies have demonstrated a pediatric epilepsy readmission rate of 6% to 10% but have not described details of the readmitted patients. We report the characteristics of pediatric patients admitted for epilepsy who were readmitted to the hospital within 30 days of discharge.
Methods:
An interdisciplinary team was established to individually review and characterize the 30-day readmissions of patients admitted for epilepsy from May 2014 to October 2016. The team contained both inpatient and outpatient neuroscience nurses, care managers, a quality outcomes manager, and child neurology physicians.
Results:
Over a 30-month period we had an all-cause 30-day readmission rate of 8.0%, which was 219 pediatric epilepsy readmissions from 169 patients. We found that 21.5% of readmissions were scheduled, 37% were for progression of chronic epilepsy, 9.6% were for recently diagnosed epilepsy, and 14.6% were for unrelated diagnoses. We classified 21.5% of readmissions as preventable and 64.9% as not preventable. Thirty-five percent of readmissions occurred within seven days of the initial discharge, including 29 of 47 (61.7%) preventable readmissions. The most common reasons for preventable readmissions were problems with the discharge care plan or medication management.
Conclusions:
We demonstrate that 21.5% of pediatric epilepsy readmissions were scheduled and 21.5% were judged to be preventable. The majority of preventable readmissions occurred within seven days of index discharge. Characterizing epilepsy readmissions is the first step in being able to reduce readmissions.
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