US pediatric trauma patient unplanned 30-day readmissions

Wheeler, Krista K.; Shi, Junxin; Xiang, Henry; Thakkar, Rajan K.; Groner, Judith A.

doi:10.1016/j.jpedsurg.2017.08.003

Cited by 14 publications

(20 citation statements)

References 37 publications

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“…This rate of unplanned operative intervention is lower than we would have normally anticipated and lower than has been reported in face-to-face orthopaedic and trauma interactions. 26 , 27 We attribute this largely to the fact that the injuries referred to the virtual fracture clinic pathway were at the lower end of complexity. Other contributing factors may be the regular collaborative quality improvement meetings and the ability to rapidly refer indeterminate diagnosis directly to either the PED or orthopaedic outpatient clinics.…”

Section: Discussionmentioning

confidence: 99%

One and done? Outcomes from 3961 patients managed via a virtual fracture clinic pathway for paediatric fractures

Kennedy

Blackburn

Barrett

et al. 2021

Journal of Children's Orthopaedics

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Purpose The aim of this paper is to describe our experience with a virtual fracture management pathway in the setting of a paediatric trauma service. Methods All patients referred to the virtual fracture clinic service from the Paediatric Emergency Department (PED) were prospectively collected. Outcome data of interest (patients discharged, referred for urgent operative treatment, referred back to emergency department for further evaluation, referred for face-to-face clinical assessment and all patients who re-presented on an unplanned basis for further management of the index injury) were compiled and collated. Cost analysis was performed using established costing for a virtual fracture clinic within the Irish Healthcare System. Results There were a total of 3961 patients referred to the virtual fracture clinic from the PED. Of these, 70% (n = 2776) were discharged. In all, 26% (n = 1033) were referred to a face-to-face appointment. Of discharged patients, 7.5% (n = 207) required an unplanned face-to-face evaluation. A total of 0.1% (n = 3) subsequently required operative treatment relating to their index injury. Implementation of the virtual fracture clinic model generated calculated savings of €254 120. Conclusion This prospective evaluation has demonstrated that a virtual fracture clinic pathway for minor paediatric trauma is safe, effective and brings significant cost savings. Level of Evidence II

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Section: Discussionmentioning

confidence: 99%

One and done? Outcomes from 3961 patients managed via a virtual fracture clinic pathway for paediatric fractures

Kennedy

Blackburn

Barrett

et al. 2021

Journal of Children's Orthopaedics

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“…Reasons for patients being admitted to a different hospital than an immediate prior admission include attending lower‐volume hospitals with earlier triage to treatment time, presenting to a non‐children's hospital and increased hospital choice in urban settings . This proportion is less than the US paediatric population, where 82.5% presented to the same hospital, possibly due to the distribution of the Australian population in major cities with multiple hospitals. However, this study used linked hospitalisation data for all Australia rather than a single study hospital, which would have missed hospitalisations of children to other surrounding hospitals, possibly providing a clearer picture of where patients attended following index admission.…”

Section: Discussionmentioning

confidence: 99%

“…The higher cost of readmission may be attributable to the increased injury severity score, likelihood of surgery, other health‐care procedures and rehabilitation following the index admission . Patients requiring readmission are likely to require surgical procedures and have long LOSs (>3 days) resulting in more expensive hospital costs at readmission …”

Section: Discussionmentioning

confidence: 99%

“…Patients with unplanned readmissions have been shown to be more likely to require an operation in their subsequent admission even if they did not have an operation in their initial admission. More than 25% of readmitted patients require a surgical procedure, and 40% of patients have a readmission LOS greater than 3 days . Patients with a chronic condition secondary to the index trauma admission have been found to be more likely to be readmitted, and readmissions typically occur within 2 weeks of discharge …”

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confidence: 99%

“…There is very little literature relating to the readmission of paediatric patients following trauma despite injury being the highest cause of hospital admission in children in Australia . Most paediatric readmission studies are limited to single institutions with small sample sizes or to selected hospitals . This research aims to examine the characteristics of readmissions following paediatric trauma in Australia over a 10‐year period, including cost, LOS and patient demographics.…”

mentioning

confidence: 99%

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Hospital readmissions in paediatric trauma patients: A 10‐year Australian review

Unsworth

Curtis

Mitchell

2018

J Paediatrics Child Health

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Aim: Readmission of paediatric trauma patients is associated with increased hospital length of stay, additional operative procedures and significant costs to the health-care system. The rates and causes of readmission of paediatric trauma patients are not well reported outside of the USA or single centres. This nation-wide study is the first in Australia to examine the readmission rates, costs and characteristics of Australian paediatric trauma patients. Methods: This was a retrospective examination of linked hospitalisation and mortality data for injured children aged 16 or younger from 1 July 2001 to 30 June 2012, readmitted to hospital within 28 days of discharge. Data including injury severity, nature of injury, episodes of care and costs were extracted from hospitalisation data. Results: There were 37 603 injury children aged ≤16 years readmitted to hospital within 28 days during the 10-year period, a readmission rate of 5.5%. The most common principal injury requiring readmission was fracture (52.6%) and burns (19.3%). A total of 66% of all patients had a readmission diagnosis of injury, complication of their initial injury or complication of surgical and medical care; 30% were readmitted for a specific procedure or follow-up care. The total cost of readmissions was AU$108 million. Conclusions: Hospital readmission rates of paediatric trauma patients in Australia are due to injury or a complication of injury and are associated with significant costs. Early identification of at-risk patients and the prevention of complications are needed to prevent the ongoing burden of readmission.

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