Readmissions within Pediatric Neurology: A Quality Improvement Initiative Involving Discharge Optimization

Objective: To examine pediatric neurology readmissions to identify potential risk factors and assess the impact of standardized discharge information for patients and families. Background: Readmission rates are a potential quality measure but aside from general pediatric studies that found patients with seizures to have readmission rates of 5–6%, there is limited data identifying risk factors for unplanned readmissions within the general pediatric neurology population. Design/Methods: In 2015 the readmission taskforce conducted a two-year retrospective review to identify drivers of readmission and develop possible interventions. A standardized discharge template for seizure patients was created and a discharge clinic was developed to expedite time to follow-up. A chart review of discharges between July 2015 and June 2016 was performed to study the effect of these interventions. Run charts were plotted on a monthly basis with intermittent statistical analysis to assess impact. Results: Monthly readmission rates from July 2015 through June 2016 ranged from 7% to 15.2%, with an overall rate of 10%. The readmission rate for new patients who followed up in either the general resident clinic or the discharge clinic was 5.4%. Upon further analysis of this cohort, all readmitted patients had a scheduled follow-up within 30 days. A run chart measuring discharge template utilization demonstrated decreased readmission rates with higher utilization. Conclusions: As seizures encompass a majority of readmissions, standardized discharge information appears to correlate with lower readmission rates, suggesting that proper patient family education may impact readmissions. However, readmission rates among patients with earlier scheduled follow-ups were higher than those without. This may imply higher complexities or other potential risk factors within this group. These reasons as well as currently limited referral, the efficacy of a discharge clinic for expedited follow-up has not yet been adequately studied. Further studies are necessary to better identify and intervene for high-risk patients. Disclosure: Dr. Heath has nothing to disclose. Dr. Ojo has nothing to disclose. Dr. Garcia has nothing to disclose. Dr. Leimkuhler has nothing to disclose.