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A Quality Improvement Intervention Bundle to Reduce 30-Day Pediatric Readmissions
Neal A deJong1, Kelly S Kimple1, Madlyn C Morreale1,2
1Department of Pediatrics, UNC School of Medicine, Chapel Hill, N.C.
Insights
Implementing a comprehensive intervention addressing social determinants of health (SDH) significantly reduced pediatric hospital readmissions. This enhanced transitional care improved outcomes for children during health crises.
Area of Science:
- Pediatric healthcare quality improvement
- Transitional care models
- Social determinants of health research
Background:
- Pediatric hospital readmissions signal care gaps, often linked to social factors beyond hospital scope.
- Effective transitional care is crucial for bridging hospital discharge and community follow-up.
- Addressing social determinants of health (SDH) is vital for holistic pediatric care.
Purpose of the Study:
- To decrease the 30-day readmission rate for pediatric patients on two general pediatric services.
- To implement and evaluate an intervention enhancing care continuity from hospital stay through discharge and follow-up.
- To assess the impact of addressing social determinants of health on readmission rates.
Main Methods:
- A multidisciplinary team developed an intervention bundle using needs assessment and evidence-based transitional care models.
- Intervention components included pre-discharge planning, SDH screening/intervention, medication reconciliation, PCP communication, transition clinic access, and a 24-hour physician line.
- Implementation occurred sequentially from October 2013 to February 2017, with readmission rate as the primary outcome.
Main Results:
- The 30-day pediatric readmission rate decreased from 10.3% pre-intervention to 7.4% during the intervention period.
- Of 1,394 families screened for adverse SDH, 48% received assistance with at least one concern.
- The average length of stay slightly increased from 4.10 days in 2013 to 4.30 days in 2017.
Conclusions:
- An intervention bundle incorporating SDH was linked to a sustained reduction in pediatric readmissions on general services.
- Transitional care addressing diverse family needs during pediatric health crises effectively reduces readmissions.
- Integrating social determinants of health into care transitions improves pediatric patient outcomes.
Introduction:
Pediatric hospital readmissions can represent gaps in care quality between discharge and follow-up, including social factors not typically addressed by hospitals. This study aimed to reduce the 30-day pediatric readmission rate on 2 general pediatric services through an intervention to enhance care spanning the hospital stay, discharge, and follow-up process.
Methods:
A multidisciplinary team developed an intervention bundle based on a needs assessment and evidence-based models of transitional care. The intervention included pre-discharge planning with a transition coordinator, screening and intervention for adverse social determinants of health (SDH), medication reconciliation after discharge, communication with the primary care provider, access to a hospital-based transition clinic, and access to a 24-hour direct telephone line staffed by hospital attending pediatricians. These were implemented sequentially from October 2013 to February 2017. The primary outcome was the readmission rate within 30 days of index discharge. The length of stay was a balancing measure.
Results:
During the intervention, the included services discharged 4,853 children. The pre-implementation readmission rate of 10.3% declined to 7.4% and remained stable during a 4-month post-intervention observation period. Among 1,394 families screened for adverse SDH, 48% reported and received assistance with ≥ 1 concern. The length of stay increased from 4.10 days in 2013 to 4.30 days in 2017.
Conclusions:
An intervention bundle, including SDH, was associated with a sustained reduction in readmission rates to 2 general pediatric services. Transitional care that addresses multiple domains of family need during a child's health crisis can help reduce pediatric readmissions.
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