Potentially Preventable 30-Day Hospital Readmissions at a Children’s Hospital

Toomey, Sara L.; Peltz, Alon; Loren, Samuel S.; Tracy, Michaela; Williams, Kathryn; Pengeroth, Linda; Marie, A; Onorato, Sarah; Schuster, Mark A.

doi:10.1542/peds.2015-4182

Cited by 103 publications

(136 citation statements)

References 30 publications

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“…29–32 Further, as many as a third of unplanned pediatric readmissions are potentially preventable. 33 Readmissions are also costly for payers, resulting in policymakers focusing on reducing readmission to optimize resource utilization. Medicare reduces reimbursement to adult facilities with high readmission rates, 34 and in some states Medicaid, including the New York, financially penalizes institutions with more than expected readmissions.…”

Section: Discussionmentioning

confidence: 99%

Risk of Hospital Readmission Among Infants With Neonatal Abstinence Syndrome

Patrick

Burke²,

Biel

et al. 2015

Hospital Pediatrics

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Objective Neonatal abstinence syndrome (NAS) is a postnatal drug withdrawal syndrome that may last for months. Our objective was to determine if infants with NAS are at increased risk for hospital readmission compared with uncomplicated term and late preterm newborns. Methods In this longitudinal retrospective cohort study, administrative data were used for all births from 2006 to 2009 in the New York State Inpatient Database. We identified infants with NAS, born late preterm or uncomplicated term, as independent groups using diagnostic codes and determined readmission rates. We fit a multivariable logistic regression model with 30-day readmission after discharge as the outcome and infant characteristics, clinical morbidities, insurance type, and length of birth hospitalization as predictors. Results From 2006 to 2009 in New York State, 700613 infants were classified as uncomplicated term, 51748 were born late preterm, and 1643 infants were diagnosed with NAS. After adjusting for confounders, infants with NAS (odds ratio [OR] 2.49, 95% confidence interval [CI] 1.75–3.55) were more likely than uncomplicated term infants to be readmitted within 30 days of birth hospitalizations. The risk of readmission was similar to late preterm infants (OR 2.26, 95% CI 2.09–2.45). Length of birth hospitalization in days was inversely related to odds of being readmitted within 30 days of birth hospitalization (OR 0.94 95% CI 0.92–0.96). Conclusions When compared with uncomplicated term infants, infants diagnosed with NAS were more than twice as likely to be readmitted to the hospital. Future research and state-level policies should investigate means to mitigate risk of hospital readmission for infants with NAS.

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Section: Discussionmentioning

confidence: 99%

Risk of Hospital Readmission Among Infants With Neonatal Abstinence Syndrome

Patrick

Burke²,

Biel

et al. 2015

Hospital Pediatrics

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“…Approximately 6.5% of children are readmitted to the hospital within 30 days of being discharged from acute care pediatric hospitals (Berry, Toomey, et al, 2013;Berry, Ziniel, et al, 2013), with the majority of these readmissions comprised of children with complex chronic conditions, technology dependency, public insurance, and recurrent problems associated with the same organ system (Berry et al, 2011). Thirty percent of these pediatric readmissions are estimated to be preventable (Toomey et al, 2016). When parents of hospitalized children report feeling unprepared for discharge, they have difficulty transitioning from hospital to home and managing their child's complex care needs (Weiss et al, 2008;Lerret & Weiss, 2011;Lerret et al, 2015), leading to problems that may result in returning to the hospital for an emergency department (ED) visit or readmission.…”

mentioning

confidence: 99%

Discharge Teaching, Readiness for Discharge, and Post-discharge Outcomes in Parents of Hospitalized Children

Weiss

Sawin

Gralton

et al. 2017

Journal of Pediatric Nursing

116

127

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“…3 Since then, there has been a significant focus on understanding the 20% to 30% of pediatric readmissions deemed potentially preventable. [4][5][6] Previous investigations have been focused on factors impacting 7-and 30-day readmissions. 7,8 This literature reveals that ∼25% of preventable pediatric 30-day readmissions 5 occur within 3 days of discharge.…”

mentioning

confidence: 99%

Pediatric Readmissions Within 3 Days of Discharge: Preventability, Contributing Factors, and Necessity

Rodriguez

Goodman

Bayldon

et al. 2019

Hospital Pediatrics

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A B S T R A C TOBJECTIVES: 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 5 .01), clinically related admission and readmission (P 5 .004), and weekday of initial discharge (P 5 .02). Seventeen percent were unnecessary per readmission provider. Clinically unnecessary readmissions were associated with Hispanic ethnicity (P 5 .02), outside-hospital transfer (P 5 .05), and problems with clinical decision-making (P 5 .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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Potentially Preventable 30-Day Hospital Readmissions at a Children’s Hospital

Cited by 103 publications

References 30 publications

Risk of Hospital Readmission Among Infants With Neonatal Abstinence Syndrome

Risk of Hospital Readmission Among Infants With Neonatal Abstinence Syndrome

Discharge Teaching, Readiness for Discharge, and Post-discharge Outcomes in Parents of Hospitalized Children

Pediatric Readmissions Within 3 Days of Discharge: Preventability, Contributing Factors, and Necessity

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