6898 Clinical audit on the factors contributing to neonatal readmissions after neonatal stay within a level 3 NICU

Objectives To identify cases of neonatal readmissions to secondary care in NHS Lanarkshire following discharge from a Level 3 neonatal unit, and the factors that may lead to these representations. Whilst perinatal factors can play a role in risk of readmission, data and literature around identifying areas of minimising avoidable readmissions remain limited. Methods Retrospective data collection over 9 months (September 2022 to May 2023) of all neonatal readmissions (within 28 days from neonatal unit discharge) at a single level 3 NICU. A Badgernet (electronic patient record) search was conducted, and further clinical outcomes and demographic data collected using Clinical Portal (patient information portal). Results 235 patients were discharged from the neonatal unit during the defined study period. 13.2% (n=31) resulted in 36 readmissions to either neonates, paediatrics or the emergency department. 70% (n=22) of those readmissions, had a TCU stay during their initial neonatal unit stay. There were a variety of causes for re-presenting (as seen in figure 1), with feeding issues (15.9%), viral illnesses (20.5%) and lethargy (9.1%) being the three commonest presenting complaints. 38.8% (n=14) of the readmissions were escalated via self-referral, whether through open access or presenting to emergency services. We looked at length of stay following readmission. 83.3% of the readmissions were in for <48 hours. We also reviewed contributing factors such as being first time parents, health equity, length of initial neonatal stay, prematurity, complexity and whether there was appropriate community liaison follow up in place. Conclusion As the majority of the re-presentations made were self-referrals, parental preparedness and patient education is vital in improving the number of avoidable readmissions. With this in mind, there is work underway to better understand staff and parental perspectives around discharge, to help improve parental confidence around discharge. This will inform how we better prepare families for discharge and become truly patient- specific in our discharge approach.