O2169: Reducing Preventable Pediatric Hospital Readmissions

Purpose/Objectives: A comprehensive review of readmissions can help identify trends in care. Providers may be unaware of their patients’ preventable readmissions and diagnostic errors. A systematic readmission review can provide valuable feedback and improve care at the provider and system levels. We aim to increase the time between preventable readmissions from a median of 7 days to 21 days within one year by creating and implementing a standardized review process for 15-day readmissions.

Design/Methods: A committee was formed to review all-cause 15-day readmissions (excluding planned and birth hospital admissions) for the Pediatric Hospital Medicine service. A readmission review guide with categories of preventable readmissions was developed. The Revised SaferDx Instrument and modified DEER taxonomy were used to assess diagnostic opportunities. Improvement opportunities were shared at division meetings and with individual discharging hospitalists. Measures include all-cause and preventable readmission rates and time between preventable readmissions (outcome); frequency of opportunities for improved care identified (process); and median length of stay (balancing).

Results: 144 readmissions were reviewed from January to December 2024. Ten (6.9%) readmissions were identified as preventable. The preventable readmission and all-cause readmission rates remained stable over time (median=7%, 2.6% respectively). Premature discharge was the most common category for preventable readmission (50%, n=5), followed by diagnostic error and inadequate discharge planning (each: 40%, n=4). The time between preventable readmissions increased from a median of 7 to 44 days. Modifiable care opportunities that did not contribute to readmissions were identified in 37.5% (n=54) of all-cause readmissions and 90% (n=9) of preventable readmissions. Diagnostic errors were identified in 7.6% (n=11) of all-cause readmissions. Median length of stay index (observed/expected) remained stable over time at 0.9.

Conclusion/Discussion: We successfully increased the time between preventable readmissions. This framework can reveal care improvement opportunities that do not impact the preventability of readmissions but contribute to continuity of care, early diagnosis, and improved clinical documentation. Next steps include a diagnostic error reduction initiative, creation of condition-specific discharge instruction templates, and adjustments to our multidisciplinary rounds to address barriers to discharge.