An Examination of Physician-, Caregiver-, and Disease-Related Factors Associated With Readmission From a Pediatric Hospital Medicine Service

OBJECTIVES: The purpose of this study was to describe the characteristics and reasons for pediatric hospital medicine readmissions. We also aimed to describe characteristics of potentially preventable cases and the reliability of classification.

METHODS: Retrospective descriptive study from December 2008 through June 2010 in a large academic tertiary care children’s hospital in Houston, Texas. Children were included if they were readmitted to the hospital within 30 days of discharge from the pediatric hospital medicine service. Reasons for readmission were grouped into three categories: physician-related, caretaker-related, and disease-related. Readmissions with physician- or caretaker-related reasons were considered potentially preventable.

RESULTS: The overall readmission rate was 3.1%, and a total of 204 subjects were included in the analysis. Lymphadenitis and failure to thrive had the highest readmission rates with 21%, and 13%, respectively. Twenty percent (n = 41/204) of readmissions were preventable with 24% (n = 10/41) being physician-related, 12% (n = 5/41) caregiver-related, and 63% (n = 26/41) for mixed reasons. When comparing classification of readmissions into preventable status, there was moderate agreement between 2 reviewers (K = 0.44, 95% confidence interval: 0.28–0.60). Among patients with preventable readmission, the probability of having had a readmission by 7 days and 15 days was 73% and 78%, respectively.

CONCLUSIONS: Reliable identification of preventable pediatric readmissions using individual reviewers remains a challenge. Additional studies are needed to develop a reliable approach to identify preventable readmissions and underlying modifiable factors. A focused review of 7-day readmissions and diagnoses with high readmission rates may allow use of fewer resources.