Pediatric cardiac readmissions: An opportunity for quality improvement?

Abstract

Hospital readmissions are increasingly becoming a metric for quality in the current landscape of changing and cost effective medicine. However, no 30-d readmission rates have been established for pediatric cardiac medical patients in the United States. Thus, the objective was to determine 30 d readmission rates and risk factors associated with readmission for pediatric cardiac patients, hypothesizing that pediatric cardiac patients would have significantly higher readmission rates than their general pediatric counterparts. This was a retrospective cohort study. The study took place at a large urban academic children's hospital. The 1124 included patients were discharged from the medical cardiology service and had an unplanned readmission within 30 d during the period of 2012-2014. Admissions, readmissions, diagnoses, demographics, weights, medications, procedures, length of stay, were all measured. There were 1993 visits and 408 (20.5%) 30-d readmissions in our study. Among the 1124 patients, 219 (19.5%) had at least one 30-d readmission. Patient factors associated with increased likelihood of 30-d readmission were younger age (median: 197.5 vs 1365.5d, P<.0001), lower discharge weight (6.2 v 14.5kg, P<.0001) and greater number of diagnoses (P<.0001). The encounter factor associated with a 30-d readmission was longer length of stay (4 vs 2d, P<0.0001). Factors associated with decreased readmissions were having had an electrophysiology procedure during their stay, taking an angiotensin converting enzyme inhibitor/angiotensin receptor blocker or taking an antibiotic. Readmissions within 30d among pediatric cardiology patients are common. The most common factors associated with readmissions are not likely to be modifiable but may serve as important prognostic indicators and as a basis for counseling.