O0569 Oct.4: 10:13am - Parent and Physician Perspectives on Reasons for Hospital Readmissions

Introduction: Hospital-to-home transitions are increasingly recognized as critical to patient safety and quality care. One in five parents report a problem in their child’s hospital discharge, such as difficulty obtaining medications or follow-up. Difficulties in the transition process lead to decreased satisfaction, higher costs, and increased readmissions. While several studies have explored parent insights into discharge needs and readiness, few have explored parent or physician perceptions of causes for pediatric readmissions.

Objective: Our objective was to investigate potential contributing factors to pediatric readmissions, from parent and physician perspectives, using qualitative methods.

Methods: We used grounded theory methodology and purposive sampling to conduct semi-structured interviews with parents, discharging and readmitting physicians, and subspecialist consultants of children who were readmitted within 30 days of initial discharge from the pediatric ward at an urban teaching hospital. Participants were asked about care transition experiences during the initial admission and causes and preventability of readmission. Data were analyzed iteratively. After every triad/tetrad, 4 researchers independently performed focused coding of transcripts, met to compare and refine codes, adapt the interview guide, develop tentative categories, and identify theoretical direction. We identified major themes, solicited feedback from participants, and inferred relationships between themes to develop a conceptual model for preventing readmissions.

Results: We conducted 53 interviews from 20 patient readmissions, including 20 parents, 20 readmitting physicians, 11 discharging physicians, and 3 consulting subspecialists. Major themes included: 1) Unclear/inconsistent roles and responsibilities cause lack of ownership in patient care, 2) Incomplete hospital-to-home transitions result in a reliance on the hospital, and 3) Lack of collaborative communication among the family, specialist, and primary team leads to discordant understanding of care plans. From these themes, we developed the conceptual model for proposed solutions to prevent readmissions shown in Figure 1.

Discussion/

Conclusion: Parent and physician perspectives increased our understanding of potential contributing factors to pediatric hospital readmissions. Readmissions may be prevented by clear definition of team member roles, improved communication among physicians and between care teams and families, and enhanced care coordination to facilitate the hospital-to-home transition.