Pediatric cardiac readmissions: An opportunity for quality improvement?

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.