Hospital Readmissions Dashboard– Developing a Review Process and Strategies for Feedback

Background:

Background: The review of readmissions can be an overwhelming task: Where to start? What cases are a priority to review? How to best engage divisions/departments when the committee identified an opportunity to improve care?

Methods:

Methods: In collaboration with the Informational Technology (IT) and Financial Planning departments, the Phoenix Children's Hospital (PCH) Readmissions Committee created a statistical dashboard reporting trended data for all-cause and unplanned 7-day and 30-day readmissions. Excluded are readmissions for planned procedures and chemotherapy, as well as inpatient psychiatric and rehabilitation admissions.

In addition to statistical measures, such as the number of discharges and readmissions, case mix index (CMI), and the average length of stay (ALOS), the dashboard includes encounter level data permitting targeted review of readmission trends. Key analyses including reviewing readmissions by:
• Care Area (Floor)
• Medical and Surgical Service Lines (Medicare Severity Diagnosis Related Groups (MS-DRG))
• Discharging Physician Specialty group, and
• Financial Class
The committee's chair monitors the dashboard, and critical findings are reviewed bi-monthly by the Readmissions Committee consisting of a multi-disciplinary group of physicians, nurses, care management/social work, pharmacy leadership, and administrative personnel.

For trends requiring additional review (i.e., service lines with significant year-over-year readmission rate increases), committee members will conduct medical chart reviews and assign readmission cases to one of nine categories qualifying the type or cause of the readmission (see Table 1). The reviewer presents the chart review results to the committee, and if the committee identifies opportunities for improvement, referral of the case(s) to the respective department for additional review.

Results:

Results: Since the implementation of Solutions for Patient Safety's Readmission Bundle in 2017, PCH has demonstrated a steady decline in the overall number of unplanned readmissions (graph 1). The Readmissions Committee effectively conducted focused reviews and escalated cases or trends to the appropriate department for additional review and mediation.

Conclusion:

Conclusion: The development of a readmissions dashboard allowed the PCH Readmissions Committee to better quantify and qualify readmissions trends in real-time and facilitate the review and prioritization of opportunities to improve patient care.