A Quality Improvement Intervention Bundle to Reduce 30-Day Pediatric Readmissions

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.