P0482 - Unplanned Hospital Readmissions after Discharge as a Failure of Care in the Pediatric Intensive Care Unit: Myth or Reality?

Background: Unplanned hospital readmission (UHR) is largely viewed as a sign of failure of care delivery. UHR is associated with increased cost, utilization and potential harm. The Center for Medicaid and Medicare Services (CMS) uses measures of UHR within 30 days of discharge as a national hospital quality metric for adult care. For children’s hospitals, the Agency for Healthcare Research and Quality’s (AHRQ) and CMS’ Pediatric Quality Measures Program (PQMP) has a 30-day All Conditions Readmission Measure. there have not been any pediatric studies that reviewed unplanned readmissions following PICU discharge. Moreover, discharge home directly from the pediatric intensive care unit (PICU) is not an uncommon event compared to the adult ICUs. The goal of this study was to analyze the reasons for UHR after PICU discharge and evaluate their potential preventability for readmission.

Objectives:
1.To review reasons for UHR to the hospital after PICU discharge
2.To determine if they could be potentially preventable by the hospital and the care provided to these patients.

Methods: This study is a retrospective review of data from the electronic health record (EHR). Two researchers independently reviewed all UHRs following discharge home from the PICU between January 2016 and December 2017. Potential preventability was determined for each UHR encounter using a Likert scale, with a third researcher reviewing any discrepancies. UHRs were categorized as potentially preventable when failures were identified in hospital care. Reasons for readmissions were also classified into different categories. UHR less than or equal to 7 days and less than or equal to 30 days were identified. These readmission cutoffs were selected based on measures from the Solutions for Patient Safety (SPS) and the AHRQ-CMS PQMP.

Results: 253 individual patients experienced a total of 646 readmissions, of which 501 (77.5%) were UHRs. Of the UHRs only 19 (3.8%) were deemed potentially preventable by the hospital. In contrast, 479 (95.6%) were ruled potentially not preventable by the hospital as the reasons for readmission were beyond the control of the hospital. 4 of the UHRs were deemed to be of unclear preventability. Of the 479 UHRs classified as potentially not preventable, the majority were comprised of encounters for new diseases, progression of the underlying disease or complications relating to the medical device/equipment that these patients were dependent on.

Conclusion: This study shows that out of a cohort of patients discharged home from a PICU, UHRs are common with the vast majority determined to be not preventable at a hospital level. Instead, conditions beyond the control of the hospital explain the UHR. Larger scale studies are needed to review pediatric hospital readmissions. However, readmission quality metrics may be inappropriate for pediatrics.