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The impact of unplanned 30-day readmission as a quality indicator in pediatric surgery
Sarah Ellul1, Mohamed Shoukry2
1Division of Paediatric Surgery, Department of Surgery, Mater Dei Hospital, Swatar, Malta.
Insights
Paediatric surgical readmissions at Mater Dei Hospital were 1.7%, with most occurring after emergency admissions. Strategies are needed to reduce these avoidable readmissions and improve patient outcomes.
Area of Science:
- Paediatric Surgery
- Healthcare Quality Improvement
- Patient Safety
Background:
- Hospital readmission rates are key indicators of healthcare quality.
- Understanding readmission patterns is crucial for risk management and service improvement.
- Paediatric surgical readmissions present unique challenges in healthcare systems.
Purpose of the Study:
- To investigate the routes and factors contributing to 30-day readmissions in paediatric surgery.
- To analyze readmission data from Mater Dei Hospital (MDH) prior to the COVID-19 pandemic.
- To identify areas for improving care and reducing paediatric surgical readmissions.
Main Methods:
- A retrospective study of paediatric surgical admissions between October 2017 and November 2019.
- Collection of demographic and clinical data, including diagnoses, procedures, and length of stay.
- Classification of readmissions into elective and emergency cohorts for comparative analysis.
Main Results:
- A total of 935 surgical admissions were reviewed, with a 1.7% readmission rate (16 patients).
- The majority of readmissions (75%) occurred after emergency admissions, with an average stay of 4.37 days.
- Nearly half of readmissions (43.7%) were post-surgical intervention, with 25% requiring further surgery.
Conclusions:
- Published data on paediatric surgical readmissions are limited, highlighting a need for further research.
- Most readmissions are preventable, emphasizing the importance of tailored strategies and multidisciplinary approaches.
- Improved communication and resource-efficient interventions are essential to decrease morbidity and prevent paediatric surgical readmissions.
Introduction:
Hospital readmission is one of the indicators used to assess quality of service provided in healthcare. Based on accumulated knowledge, risk management teams assess data related to readmissions to find curative solutions for underlying factors. The current article's aim is investigating readmission routes within the workplace in paediatric surgery service during the first 30 days post discharge from Mater Dei Hospital (MDH).
Materials And Method:
A retrospective study of children's hospital readmissions between October 2017 and November 2019 was performed, strictly before COVID-19 pandemic. Demographics and clinical records including age, gender, pre-existing comorbidities, diagnosis during primary admission and readmission, procedure carried out, ASA grade, length of stay, and outcomes were collected. All children re-admitted under a single paediatric surgical department within 30 days from initial admission to tertiary referral hospital were included. Patients undergoing emergency visitation without subsequent admissions were excluded. Readmissions were classified into cohorts: elective and emergency, depending on the nature of primary admission. Contributing factors and outcomes were compared.
Results:
935 surgical admissions (221 elective and 714 emergencies) were registered at MDH over the given period, with an average hospital stay of 3.62 days. Total readmission rate was 1.7% (n = 16). 25% (n = 4) of readmissions were post elective, 75% (n = 12) post emergency admission, with an average stay of 4.37 days and no mortalities. 43.7% (n = 7) were re-admissions post-surgical intervention. Further surgical interventions were necessary in 25% (n = 4) of readmitted patients, the remainder (n = 12) treated conservatively.
Conclusion:
Published reports concerning paediatric surgical readmission rates are limited, challenging healthcare systems. Most readmissions area voidable; therefore, healthcare workers must provide adequate strategies tailored to their resources, efficient multidisciplinary approaches with improved communication to decrease morbidity and prevent readmissions.
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