Open Access

ARTICLE

Pediatric cardiac readmissions: An opportunity for quality improvement?

Jeffrey H. Sacks^1,2, Michael Kelleman², Courtney McCracken², Michelle Glanville¹, Matthew Oster^1,2

1 Children’s Healthcare of Atlanta, Atlanta, GA, USA
2 Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA

* Corresponding Author: Jeffrey H. Sacks, Children’s Healthcare of Atlanta, 2835 Brandywine Rd, #300, Atlanta, GA 30341, USA. Email:

Congenital Heart Disease 2017, 12(3), 282-288. https://doi.org/10.1111/chd.12436

Abstract

Objective: 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.
Design: This was a retrospective cohort study.
Setting: The study took place at a large urban academic children’s hospital.
Patients: 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.
Measures: Admissions, readmissions, diagnoses, demographics, weights, medications, procedures, length of stay, were all measured.
Results: 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 1365.5 d, P < .0001), lower discharge weight (6.2 v 14.5 kg, 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 2 d, 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.
Conclusions: Readmissions within 30 d 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.

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