Clinical question: What is the epidemiology of 15-day readmissions to a children’s hospital?
Background: Readmissions are a common event in the adult population. Given the national focus on accountable care across the continuum, the Centers for Medicare & Medicaid Services (CMS) has devoted increasing attention to readmissions as a reportable quality metric in certain conditions and a target for improvement. Recommendations for pediatric patients are currently not available, primarily due to limited evidence.
Study design: Retrospective chart review.
Setting: Tertiary-care children’s hospital.
Synopsis: Of the 30,188 admissions over a two-year period, 2,546 (8.4%) resulted in readmission within 15 days. There were a total of 1,435 individual patients who were readmitted, for an average readmission rate of 1.8 per patient. Oncology patients represented the most likely group of patients to be readmitted (13.9%) and had the most number of readmissions per patient (4.1). Children with acute infectious disease, newborns, and patients with neurologic diseases represented 11.4%, 11.1%, and 10% of the readmitted patients, respectively.
Children with short-bowel syndrome and biliary atresia had a high number of readmissions per patient: 3.9 and 3.8, respectively. The majority of readmissions were unplanned (79.4%) and occurred in patients with an underlying chronic condition (78%). Readmissions 7 days from discharge accounted for 59.5% of the total, with the remaining 40.5% occurring between eight and 15 days of discharge.
This study provides one of the more comprehensive pictures of readmissions to a children’s hospital. Although the data are limited by an inability to account for readmissions to and from other facilities, they nonetheless clearly differentiate pediatric readmissions from those in an adult population.
Bottom line: Pediatric readmissions are quantitatively and qualitatively different from adult readmissions.
Citation: Gay JC, Hain PD, Grantham JA, Saville BR. Epidemiology of 15-day readmissions to a children’s hospital. Pediatrics. 2011;127:e1-e8.