Risk Factors of Readmission to Pediatric Intensive Care Unit Within 1 Year: A Case-Control Study

Ding, Min; Yang, Chun‐Feng; Li, Yumei

doi:10.3389/fped.2022.887885

Cited by 5 publications

(3 citation statements)

References 30 publications

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“…Patients with early readmissions are associated with increased hospital stay, cost, morbidity and mortality. Lower early readmission rate is typically reported for discharged pediatric PICU patients (1.2-3.7%) [46][47][48][49][50] compared to the target of 4% set by ESICM for adults [10]. Ensuing the OPDSA cycle, we observed readmission rates for the years 2017 and 2018 which were zero (0), as demonstrated in Table 2.…”

Section: Icu Readmission Rate Within 48 H Of Icu Dischargementioning

confidence: 59%

Key process and outcome indicators on quality and safety of care for critically ill pediatric patients according to international standard organization protocols: a four-year follow-up study

2023

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The European Society of Intensive Care Medicine (ESICM) suggests nine quality and safety indicators of care for critically ill patients. The aim of the present study was to examine the Key Process and Outcome Indicators (KPOIs) chosen according to International Standard Organization (ISO) protocols in a Greek Pediatric Intensive Care Unit (PICU). Two structure, one process, and four outcome indicators were examined in a stepwise approach according to Observe-Plan-Do-Study-Act (OPDSA) cycles, in an observational four-year cohort study (2017–2020). Two structure indicators—that ICUs fulfil national requirements to provide intensive care and 24-h consultant availability were requirements for the creation of the PICU and considered standards of care. One process indicator—Standardized Handover Procedure was transformed from handwritten (2017–2018) into electronic form (2019–2020) and 100% compliance rates throughout the four years were recorded. 96, 85, 103 and 94 patients were admitted in 2017, 2018, 2019 and 2020 with median (IQR) Pediatric Risk of Mortality III-24 h scores of 10 (6.25–17), 10 (6–13), 8 (5–13) and 8 (6.75–12), respectively. Mortality rates were 24%, 11.8%, 17.5%, 16%, and Standardized Mortality Ratio (SMR) were 1.42, 0.92, 1.56 and 1.33, correspondingly. No early (<48 h after PICU discharge) readmissions were recorded for 2017 and 2018, only 1 in 2019 (0.8%) and none in 2020. Catheter Related Bloodstream Infection rates were 1.37:1000, 1.37:1000, 1.26:1000 and 1.39:1000 catheter days, respectively. Unplanned extubation rate was 10.30% in 2019 and 5.72% and 3.91:1000 ventilation days in 2020. In conclusion, ISO implementation of our unit was the trigger for internal PICU audit and external benchmarking. OPDSA cycles, following small steps at a time, in an iterate cycle of evolution, facilitated our actions. The majority of the KPOIs examined in our study was within international PICUs reference values.

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Section: Icu Readmission Rate Within 48 H Of Icu Dischargementioning

confidence: 59%

Key process and outcome indicators on quality and safety of care for critically ill pediatric patients according to international standard organization protocols: a four-year follow-up study

2023

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“…Furthermore, our finding of PICU readmission mainly due to respiratory conditions among CMC was similar to that reported by a previous study. [ 18 ] Although the etiology of pneumonia was not accounted for in our cohort, Thomson et al . observed a similar pattern of prevalent neurological system involvement, multiple CCCs, feeding technology dependence, and high rates of PICU admission in children with aspiration pneumonia compared with non-aspiration pneumonia.…”

Section: Discussionmentioning

confidence: 86%

Unplanned Readmissions in Children with Medical Complexity in Saudi Arabia: A Large Multicenter Study

Alotaibi,

Alkhalaf,

Alshalawi

et al. 2024

Saudi Journal of Medicine &Amp; Medical Sciences

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Background: Children with medical complexity (CMC) account for a substantial proportion of healthcare spending, and one-third of their expenditures are due to readmissions. However, knowledge regarding the healthcare-resource utilization and characteristics of CMC in Saudi Arabia is limited. Objectives: To describe hospitalization patterns and characteristics of Saudi CMC with an unplanned 30-day readmission. Methodology: This retrospective study included Saudi CMC (aged 0–14 years) who had an unplanned 30-day readmission at six tertiary centers in Riyadh, Jeddah, Dammam, Alahsa, and Almadina between January 2016 and December 2020. Hospital-based inclusion criteria focused on CMC with multiple complex chronic conditions (CCCs) and technology assistance (TA) device use. CMC were compared across demographics, clinical characteristics, and hospital-resource utilization. Results: A total of 9139 pediatric patients had unplanned 30-day readmission during the study period, of which 680 (7.4%) met the inclusion criteria. Genetic conditions were the most predominant primary pathology (66.3%), with one-third of cases (33.7%) involving the neuromuscular system. During the index admission, pneumonia was the most common diagnosis (33.1%). Approximately 35.1% of the readmissions were after 2 weeks. Pneumonia accounted for 32.5% of the readmissions. After readmission, 16.9% of patients were diagnosed with another CCC or received a new TA device, and the in-hospital mortality rate was 6.6%. Conclusion: The rate of unplanned 30-day readmissions in children with medical complexity in Saudi Arabia is 7.4%, which is lower than those reported from developed countries. Saudi children with CCCs and TA devices were readmitted approximately within similar post-discharge time and showed distinct hospitalization patterns associated with specific diagnoses. To effectively reduce the risk of 30-day readmissions, targeted measures must be introduced both during the hospitalization period and after discharge.

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“…Therefore, by using insurance-based administrative data sets to overcome limitations of previous studies and leveraging a validated algorithm based on International Classification of Diseases, Ninth Revision (ICD-9) and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes to identify pediatric ARDS, 16 we aimed to determine the burden of 1-year readmission in survivors of ARDS. We assessed 3 key index hospitalization exposures—(1) the presence of a complex chronic condition (CCC) 17 , 18 at discharge, (2) receipt of a new tracheostomy, and (3) index hospitalization length of stay (LOS) 18 —for their association with 1-year readmission in survivors of algorithm-identified ARDS. We hypothesized that readmission would occur in one-quarter of survivors and that the presence of a respiratory CCC, receipt of a tracheostomy during index admission, and longer LOS would be associated with increased hospital readmission after discharge.…”

Section: Introductionmentioning

confidence: 99%

Readmission Rates After Acute Respiratory Distress Syndrome in Children

Keim,

Hsu,

Pinto

et al. 2023

JAMA Netw Open

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ImportanceAn increasing number of children survive after acute respiratory distress syndrome (ARDS). The long-term morbidity affecting these survivors, including the burden of hospital readmission and key factors associated with readmission, is unknown.ObjectiveTo determine 1-year readmission rates among survivors of pediatric ARDS and to investigate the associations of 3 key index hospitalization factors (presence or development of a complex chronic condition, receipt of a tracheostomy, and hospital length of stay [LOS]) with readmission.Design, Setting, and ParticipantsThis retrospective cohort study used data from the commercial or Medicaid IBM MarketScan databases between 2013 and 2017, with follow-up data through 2018. Participants included hospitalized children (aged ≥28 days to &lt;18 years) who received mechanical ventilation and had algorithm-identified ARDS. Data analysis was completed from March 2022 to March 2023.ExposuresComplex chronic conditions (none, nonrespiratory, and respiratory), receipt of tracheostomy, and index hospital LOS.Main Outcomes and MeasuresThe primary outcome was 1-year, all-cause hospital readmission. Univariable and multivariable Cox proportional hazard models were created to test the association of key hospitalization factors with readmission.ResultsOne-year readmission occurred in 3748 of 13 505 children (median [IQR] age, 4 [0-14] years; 7869 boys [58.3%]) with mechanically ventilated ARDS who survived to hospital discharge. In survival analysis, the probability of 1-year readmission was 30.0% (95% CI, 29.0%-30.8%). One-half of readmissions occurred within 61 days of discharge (95% CI, 56-67 days). Both respiratory (adjusted hazard ratio [aHR], 2.69; 95% CI, 2.42-2.98) and nonrespiratory (aHR, 1.86; 95% CI, 1.71-2.03) complex chronic conditions were associated with 1-year readmission. Placement of a new tracheostomy (aHR, 1.98; 95% CI, 1.69-2.33) and LOS 14 days or longer (aHR, 1.87; 95% CI, 1.62-2.16) were associated with readmission. After exclusion of children with chronic conditions, LOS 14 days or longer continued to be associated with readmission (aHR, 1.92; 95% CI, 1.49-2.47).Conclusions and RelevanceIn this retrospective cohort study of children with ARDS who survived to discharge, important factors associated with readmission included the presence or development of chronic medical conditions during the index admission, tracheostomy placement during index admission, and index hospitalization of 14 days or longer. Future studies should evaluate whether postdischarge interventions (eg, telephonic contact, follow-up clinics, and home health care) may help reduce the readmission burden.

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Risk Factors of Readmission to Pediatric Intensive Care Unit Within 1 Year: A Case-Control Study

Cited by 5 publications

References 30 publications

Key process and outcome indicators on quality and safety of care for critically ill pediatric patients according to international standard organization protocols: a four-year follow-up study

Key process and outcome indicators on quality and safety of care for critically ill pediatric patients according to international standard organization protocols: a four-year follow-up study

Unplanned Readmissions in Children with Medical Complexity in Saudi Arabia: A Large Multicenter Study

Readmission Rates After Acute Respiratory Distress Syndrome in Children

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