One of the key indicators of the quality of a hospital’s care is how frequently its patients are readmitted within a month after being discharged. A study this month examined readmission rates for pediatric patients and found that nearly 30 percent of them may have been preventable.
The study, published online by the journal Pediatrics, reviewed the medical records and conducted interviews with clinicians and parents of 305 children who were readmitted within 30 days to Boston Children’s Hospital between December 2012 and February 2013. It excluded planned readmissions such as those for chemotherapy.
Overall, 6.5 percent of patients were readmitted during the study period.
The study found that 29.5 percent of the pediatric readmissions were potentially preventable. In more than three-quarters of those cases, researchers determined that hospital-related factors played a role. A significantly smaller proportion were related to the patient (39.2 percent), often because of issues that arose after discharge, or the primary care physician (14.5 percent). (Multiple factors played a role in some patients’ readmissions, so the total exceeds 100 percent.)
The most common hospital-related reasons had to do with how patients are assessed, postoperative complications or hospital-acquired conditions.
“One of the things we need to improve upon is engaging families at the time of discharge around how we’re feeling and how they’re feeling about the status of the child at that point in time,” said Dr. Sara Toomey, the study’s lead author, who is the medical director of patient experience at Boston Children’s Hospital and an assistant professor at Harvard Medical School.
Sometimes clinicians and family members may be overly optimistic about a child’s readiness to go home, Toomey said.
When policymakers discuss the importance of reducing hospital readmissions, they typically focus on older patients, who make up a much larger proportion of hospital patients than do pediatric patients. The Medicare program, which provides health benefits for Americans age 65 and older, imposes financial penalties on hospitals whose readmission rates are too high.
The federal Centers for Medicare & Medicaid Services doesn’t penalize hospitals for pediatric readmissions, but a growing number of states are doing so, the study found.
Readmissions will never be completely avoidable, Toomey said. Still, “when you have a child coming home from the hospital, there are things you need to know, and the more active people are in creating a plan and making sure they understand it, the better that will help their children.”
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