Preventability of early readmissions at a children's hospital

Abstract

Objective: To determine whether pediatric readmissions within 15 days of discharge were considered preventable.

Methods: Retrospective chart review of 200 randomly selected readmissions (8% of all readmissions) occurring within 15 days of discharge from a freestanding children's hospital between January 1, 2007, and December 31, 2008. The degree of preventability was assessed independently for each case by 4 pediatricians using a 5-point Likert scale and was correlated with chronic conditions and reason for index admission with 3M's Clinical Risk Groups and All Patient-Refined Diagnostic-Related Groups, respectively.

Results: The rate of 15-day readmissions considered more likely preventable by the discharging hospital was 20.0% (1.7% of total admissions, 95% confidence interval 14.8%-26.4%). Reviewers failed to reach initial consensus in 62.5% of cases, although final consensus was achieved after the panel reviewed cases together. Consensus ratings served as the standard for the remainder of the study. Readmissions in children with malignancies were considered less preventable than those in children with other chronic illnesses (5.8% vs 25.8%, P = .003). Readmissions following surgical admissions were considered more likely preventable than those following medical admissions (38.9% vs 15.9%, P = .002). Central venous catheter infections and ventricular shunt malfunctions accounted for 8.5% of all readmissions reviewed.

Conclusions: Although initial consensus about which readmissions were more likely preventable was difficult to achieve, the overall rate of preventable pediatric 15-day readmissions was low. Pediatric readmissions are unlikely to serve as a highly productive focus for cost savings or quality measurement.