522 - Assessment of Seven- and Thirty-Day Readmissions and Preventability at a Canadian Tertiary Pediatric Hospital

Publication Number: 522.3990

Sarah R. Tougas, University of Calgary, Calgary, AB, Canada; Jena Shank, University of Calgary, Airdrie, AB, Canada; Shelina Jamal, University of Ca=ary Cumming School of Medicine, Calgary, AB, Canada; Ximena X. Huertas Mancipe, University of Ca=ary Cumming School of Medicine, Calgary, AB, Canada; Jennifer Thull-Freedman, University of Calgary, Calgary, AB, Canada

Background: Many children’s hospitals measure readmission rates as a quality indicator. Unplanned readmissions burden both families and the healthcare system and may reflect gaps in care delivery. The 30-day readmission rate at our urban Canadian tertiary pediatric hospital historically has been similar to the 8% rate reported at Canadian teaching hospitals. While characteristics and preventability of pediatric readmissions have been studied in a small number of studies elsewhere, we lacked a local understanding of characteristics of readmitted patients and preventability.

Objective: To describe characteristics and assess preventability of patients readmitted within 7 and 30 days of hospital discharge at our tertiary children’s hospital.

Design/Methods: We performed a cross-sectional study of 100 randomly sampled health records of patients readmitted within 7 days and another 100 records for those readmitted within 30 days from January 1 – December 31, 2023. All readmissions were eligible for inclusion. Three reviewers independently reviewed 50-150 records each, resolving disagreements by consensus. Preventability was classified according to a published definition. Data were analyzed descriptively, 95% confidence intervals were calculated for proportions, and chi squared analysis assessed associations with service type.

Results: During the study period, there were 9530 discharges from our institution: 61.5% from non-oncology medical services, 4.6% from oncology, 24.9% from surgical services, and 9.0% from psychiatry. There were 268 readmissions within 7 days and 749 readmissions within 30 days, resulting in a 7-day readmission rate of 2.8% and a 30-day rate of 7.9%. Among the records analyzed for 30-day readmissions, 60% were to non-oncology medical services (2 of 60 planned), 18% to oncology (4 of 18 planned), 14% to surgical services (0 planned), and 13% to psychiatry (0 planned). The likelihood of readmission varied by service type, with oncology patients experiencing higher rates and surgical patients experiencing lower rates (p < 0.01). 22% of the 30-day readmissions were classified as possibly preventable (95% CI: 14.4-29.6%). The most common potentially preventable reasons included incomplete treatment of infection, insufficient pain control, lack of mental health support, and post-operative sequelae.

Conclusion(s): Pediatric readmission rates and preventability assessments were similar to reports from other centers. Identifying local sources of potentially preventable readmission offers opportunities for quality improvement initiatives.