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

Abstract

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.

Preventability of 7-Day Versus 30-Day Readmissions at an Academic Children’s Hospital

“…Readmissions occurring within 7 days were more than twice as likely to be judged as preventable as those occurring between 8 and 30 days after discharge, although this result was not statistically significant. However, this difference is consistent with other studies of preventability, 16,18,19,22 and this finding supports the notion that using a shorter readmission time frame could represent a more meaningful quality metric. Our study also confirmed findings from other studies concerning the readmitted patient population: that they have high medical complexity, have longer LOS, and are more likely to have public insurance.…”

“…A recent study by Rodriguez et al 22 further highlights the challenge of determining preventability. The researchers deemed 48% of 3-day readmissions preventable by external chart review, but only 29% to 35% were preventable when determined by discharging and readmitting providers.…”

“…Shorter readmission time frames have been examined in both pediatric and adult populations. 16,[18][19][20][21][22] An analysis by Hain et al 16 of 15-day readmissions in pediatrics found that 20% of cases were deemed preventable, but this was not compared with 30-or 7-day rates. In another study of pediatric patients, using a different readmission preventability tool, Toomey et al 19 found that 30% of 30-day readmissions were preventable and that readmissions that occurred closer to the index admission were more likely to be deemed preventable.…”

Comparing Software Determination of Readmission Preventability With Chart Review, Provider, and Family Assessments

“…Data regarding the preventability, contributing factors, and necessity of readmission for this group of patients were explored in a previous publication. 5 3M Software Data 3M software was used to evaluate the 3-day readmission cases that met the study criteria. The 3M software determination of clinical relatedness between admission and readmission and the potential preventability of readmission were recorded for each readmission.…”

“…Further, research comparing family and readmission provider perspectives has revealed differences in assessments of preventability. 4,5 Several states' Medicaid programs have addressed this challenge by using a software-based algorithm that uses administrative data to determine a readmission' s preventability, the 3M Potentially Preventable Readmissions Grouping Software (3M software). [6][7][8][9][10] In some cases, this information is used by state Medicaid programs to levy financial penalties for hospitals.…”