Study Finds Reducing Readmissions for Children Needs Attention, Too

By now, the need to reduce 30-day readmissions, especially for seniors, is well-known: Medicare penalizes hospitals whose readmission rates are too high.

But what about the other end of the age spectrum? While children may not account for as many hospitalizations as the elderly, a new study finds that their return visits may be a bigger problem.

The journal Pediatrics just published a study from a free-standing children’s hospital involving 305 patients younger than 18 years old, who were readmitted between December 2012 and February 2013. Researchers found that nearly 30% of the readmissions were preventable, and most happened less than a week after discharge. The overall readmission rate was 6.5%.

The researchers reviewed hospital records and then did 1459 interviews surrounding the cases—reaching parents, hospital clinicians, and primary care providers. Children who were at least 13 years old were interviewed, too. In 31.2% of the cases, the interviews brought new information to light.

Overall, 29.5% of readmissions were preventable, and hospital factors played a role in 36.2% of the cases. Less common were factors related to the patient (18.1%) or the primary care provider (4.6%). Some readmissions were due to multiple factors. Hospital-acquired infections, complications after surgery and errors in the way patients were assessed were among the common causes.

The study found that preventable readmissions usually happened quickly—the median time after discharge was 5 days, compared with 9 for readmissions that were not preventable. In preventable cases, patients were more likely to be readmitted for the same condition that caused the first inpatient stay.

"On the basis of this study, targets for reducing readmissions might include addressing hospital factors, such as the need for improved caregiver education, meeting social needs, and increasing rates of post-discharge follow-up," the authors conclude. "More broadly, parent and provider interviews offer important information regarding potential preventability and contributing factors for preventability."

Sara Toomey, MD, MPH, MSc, the lead author, told Kaiser Health News that the parents and doctors may be overly optimistic when assessing a child’s readiness to go home. Better engagement is needed with family caregivers about how ready they are to care for children, she said.

Toomey is the medical director of patient experience at Boston Children’s Hospital, where the study took place.

Reference

Toomey SL, Peltz A, Loren S, et al. Potentially preventable 30-day hospital readmissions at a children’s hospital [published online July 22, 2016j. Pediatrics. 2016; http://bit.ly/2amsRgu