A Validated Method for Identifying Unplanned Pediatric Readmission

Abstract

Objective: We sought to 1) validate the accuracy of pre-encounter hospital designation as a novel way to identify unplanned pediatric readmissions, and 2) describe the most common diagnoses for unplanned readmissions among children. Methods:We examined all hospital discharges from two tertiary care children's hospitals excluding deaths, normal newborn discharges, transfers to other institutions, and discharges to hospice. We performed blinded medical record review on 641 randomly selected readmissions to validate the pre-encounter planned/unplanned hospital designation. We identified the most common discharge diagnoses associated with subsequent 30-day unplanned readmissions.Results: Among 166,994 discharges (Hospital A: n=55,383; Hospital B: n=111,611), the 30-day unplanned readmission rate was 10.3% (Hospital A) and 8.7% (Hospital B). The hospital designation of "unplanned" was correct in 98% (Hospital A) and 96% (Hospital B) of readmissions; the designation of "planned" was correct in 86% (Hospital A) and 85% (Hospital B) of readmissions. The most common discharge diagnoses for which unplanned 30-day readmissions occurred were oncologic conditions (up to 38%) and non-hypertensive congestive heart failure (about 25%), across both institutions.Conclusions: Unplanned readmission rates for pediatrics, using a validated, accurate, pre-encounter designation of "unplanned," are higher than previously estimated. For some pediatric conditions unplanned readmission rates are as high as readmission rates reported for adult conditions. Anticipating unplanned readmissions for high-frequency diagnostic groups may help focus efforts to reduce the burden of readmission for families and facilities.3

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

“…Previous researchers have attempted to develop heuristics to retrospectively identify preventable readmissions among large-scale patient data sets. 1,14,15 Our results support previous findings that cases with clinically related causes of admission and readmission have a significantly higher rate of preventability than unrelated cases. 5 Therefore, excluding cases of clinically unrelated admission and readmission may be an appropriate initial filter to search for potentially preventable cases.…”

Postdischarge Nurse Home Visits and Reuse: The Hospital to Home Outcomes (H2O) Trial

“…Our primary outcome was a composite measure of unplanned 30-day acute health care reuse (unplanned readmission, ED, or urgent care visit). Unplanned readmissions were identified by using a validated definition 22 ; data were obtained from hospital administrative data because CCHMC is the only admitting pediatric facility within the study area. We supplemented CCHMC data with an administrative data set used to capture most regional inpatient and/ or ED facilities.…”

Repeated Critical Illness and Unplanned Readmissions Within 1 Year to PICUs*

“…Such readmissions may increase as the number of children with CCC grows. Appreciating which patients are more likely to experience readmission could be helpful in providing tailored anticipatory guidance about repeated illness and readmission risks to families (31), as well as concentrate resource planning and efforts to mitigate preventable readmissions (32). For instance, high-risk patients might be kept in the PICU longer to ensure clinical stability, transferred to intermediate care, or provided more intense disposition planning and outpatient follow-up.…”