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Pediatric Readmissions Within 3 Days of Discharge: Preventability, Contributing Factors, and Necessity
Victoria A Rodriguez1,2, Denise M Goodman3,2, Barbara Bayldon3,2
1Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois varodriguez@luriechildrens.org.
Insights
Nearly half of pediatric readmissions within 3 days are preventable. Improving clinical decision-making and discharge processes can reduce these readmissions.
Area of Science:
- Pediatric Healthcare
- Patient Readmission Analysis
- Healthcare Quality Improvement
Background:
- Pediatric 30-day readmissions represent a significant healthcare burden, with a substantial portion deemed preventable.
- Approximately 25% of pediatric readmissions occur within 3 days of initial discharge, highlighting a critical window for intervention.
Purpose of the Study:
- To investigate the preventability and contributing factors of pediatric readmissions occurring within 3 days of discharge.
- To assess the necessity of these early readmissions from a clinical perspective.
Main Methods:
- A single-site observational study was conducted at a tertiary children's hospital.
- Data collection involved chart reviews and interviews with healthcare providers and families of readmitted patients.
- Qualitative content analysis was used to analyze provider and family perspectives on discharge readiness and readmission necessity.
Main Results:
- Chart reviewers identified 48% of 3-day readmissions as preventable, contrasting with lower rates reported by discharge providers (29%), readmission providers (35%), and families (25%).
- Key contributing factors to preventable readmissions included clinical decision-making errors (43%) and discharge process issues (20%).
- Readmission provider assessments indicated 17% of readmissions were clinically unnecessary, associated with Hispanic ethnicity, outside-hospital transfers, and clinical decision-making problems.
Conclusions:
- Over half of 3-day pediatric readmissions were considered preventable or unnecessary.
- Enhancing clinical decision-making, optimizing discharge processes, and fostering consensus between families and providers are crucial for reducing early readmissions.
Objectives:
Among pediatric 30-day readmissions, 20% to 30% are preventable, and ∼25% are within 3 days of discharge. We investigated the preventability, contributing factors, and necessity of 3-day pediatric readmissions.
Methods:
We enrolled patients who were readmitted within 3 days at a freestanding tertiary children's hospital in this single-site observational study from July 2016 to February 2017. We performed chart reviews and interviews with discharge and readmission providers and families. Preventability was defined by the chart reviewer's determination. Contributing factors for readmission, demographics, and clinical characteristics were analyzed for association with preventability and necessity. We analyzed qualitative data using content analysis.
Results:
Of the 125 readmission cases included, 60 (48%) were preventable per chart reviewer compared with 27 of 92 (29%) per discharge providers, 33 of 93 (35%) per readmission providers, and 9 of 36 (25%) per families. Preventability was associated with the following contributing factors: problems with clinical decision-making in 54 of 125 (43%) readmissions (P < .001), issues with the discharge process in 25 of 125 (20%) readmissions (P = .01), clinically related admission and readmission (P = .004), and weekday of initial discharge (P = .02). Seventeen percent were unnecessary per readmission provider. Clinically unnecessary readmissions were associated with Hispanic ethnicity (P = .02), outside-hospital transfer (P = .05), and problems with clinical decision-making (P = .01). Qualitative data highlighted disagreement on readiness for discharge and the necessity of readmission among various providers and family.
Conclusions:
More than one-half of 3-day readmissions were considered either preventable or unnecessary. Clinical decision-making, discharge processes, and improving consensus among families and providers may be valuable areas for future efforts to reduce readmission.
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