Advertisement

Pediatric Surgery International

, Volume 35, Issue 5, pp 597–602 | Cite as

Readmission within 30 days of discharge (ReAd): a quality-of-care indicator in paediatric surgery

  • Alice Louise Mears
  • May Bisharat
  • Feilim Murphy
  • Chandrasen K. SinhaEmail author
Original Article

Abstract

Purpose

Following a previously published 1 year audit of readmissions, this is a reaudit of our readmission rate (ReAd) in paediatric surgery, asking: is ReAd reproducible, can it be an indicator of quality of care in paediatric surgery, and can it be improved?

Method

Prospectively collected Hospital Episode statistics were used to identify readmissions over 1 year. Patients were subdivided into emergency vs elective regarding the first admission and outcomes compared including with our previously published ReAd data.

Results

2616 children (67% male) were admitted during 2016: 1398 (53%) elective and 1218 (47%) emergency admissions. The overall ReAd was 0.9%, comparable to and lower than our previously published rate of 2%. The commonest cause for readmission was appendicitis-related (22%). The emergency cohort ReAd was 1.5% (18/1218) compared to 0.4% (5/1398) in the elective cohort, 4× higher (p = 0.002). In the emergency cohort, the commonest causes for readmission were abdominal pain and perforated appendicitis. 80% of elective group readmissions were related to urological procedures. More of these required surgical intervention to treat (80% vs 22%) (p = 0.03).

Conclusion

(1) ReAd is a reproducible and reducible quality-of-care indicator in paediatric surgery. (2) Emergency admission is a risk factor for readmission. (3) Appendicectomy was associated with the highest ReAd.

Keywords

Paediatric surgery 30-Day readmission Readmission Quality-of-care indicator 

Notes

Compliance with ethical standards

Conflict of interest

No conflicts of interest to declare.

References

  1. 1.
    Intelligent monitoring NHS acute hospitals indicators and methodology (2014) Care quality commission. http://www.cqc.org.uk/files/20141127. Accessed 1 May 2018
  2. 2.
    van Walraven C, Jennings A, Forster A (2012) A meta-analysis of hospital 30-day avoidable readmission rates. J Eval Clin Pract 18(6):1211–1218CrossRefGoogle Scholar
  3. 3.
    Gani F, Lucas DJ, Kim Y et al (2015) Understanding variation in 30-day surgical readmission in the era of accountable care effect of the patient, surgeon, and surgical subspecialties. JAMA Surg 150:1042–1049CrossRefGoogle Scholar
  4. 4.
    Fischer C, Lingsma HF, Maran-van de Mheen PJ (2014) Is the readmission rate a valid quality indicator? A review of the evidence. PLoS One 9(11):e112282;1–9Google Scholar
  5. 5.
    Burjonrappa S, Theodorus A, Shah A, Cohen IT (2015) Pediatric surgery readmissions: a root cause analysis. Pediatr Surg Int 31(6):551–555CrossRefGoogle Scholar
  6. 6.
    Bardach N, Vittinghoff E, Asteria-Penaloza R, Edwards J, Yazdany J, Lee H, Boscardin WJ, Cabana M, Dudley RA (2013) Measuring hospital quality using pediatric readmission and revisit rates. Pediatrics 132(3):426–429CrossRefGoogle Scholar
  7. 7.
    NICE:Costing statement: Transition between inpatient hospital settings and community or care home settings (2015) https://www.nice.org.uk/guidance/ng27/resources/costing-statement-2187244909. Accessed 1 May 2018
  8. 8.
    Sinha CK, Decker E, Rex D, Mukhtar Z, Murphy F, Nicholls E, Okoye B, Giuliani S (2016) Thirty days readmission in paediatric surgery: the first UK experience. J Ped Surg 51:1877–1880Google Scholar
  9. 9.
    Berry J, Toomey S, Zaslavsky A, Jha A, Nakamura M, Klein D, Feng J, Shulma S, Chiang V, Kaplan W, Hall M, Schuster M (2013) Pediatric readmissions and variability across hospitals. JAMA 309(4):372–380CrossRefGoogle Scholar
  10. 10.
    Feudnter C, Pati S, Goodman D, Kahn M, Sharma V, Hutto J, Levin J, Slonim A, Hall M, Shah S (2010) State-level child health system performance and the likelihood of readmission to children’s hospitals. J Ped 157(1):98–102CrossRefGoogle Scholar
  11. 11.
  12. 12.
    Thornton GCD, Goldacre MJ, Goldacre R, Howarth LJ (2015) Diagnostic outcomes following childhood non-specific abdominal pain: a record-linkage study. Arch Dis Child 101:299–299Google Scholar
  13. 13.
    Barker P, Jutley R, Youngson G (2002) Hospital re-admission in children with non-specific abdominal pain. Pediatr Surg Int 16(5–6) 341–343Google Scholar
  14. 14.
    Donze J, Lipsitz S, Bates D, Schnipper J (2013) Causes and patterns of readmissions in patients with common comorbidities: retrospective cohort study. BMJ 347:f7171CrossRefGoogle Scholar
  15. 15.
    Hansen LO, Young RS, Hinami K, Leung A, Williams MV (2011) Interventions to reduce 30-day rehospitalization: a systematic review. Ann Intern Med 155:520–528CrossRefGoogle Scholar
  16. 16.
    Bradley E, Curry L, Horwitz L, Sipsma H, Thompson J, Elma MA, Walsh M, Krumholz H (2012) Contemporary Evidence about hospital strategies for reducing 30-day readmissions. J Am Coll Cardiol 60(7):607–614CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Alice Louise Mears
    • 1
  • May Bisharat
    • 1
  • Feilim Murphy
    • 2
  • Chandrasen K. Sinha
    • 2
    Email author
  1. 1.Department of UrologyGreat Ormond Street Hospital for Children NHS Foundation TrustLondonUK
  2. 2.Department of Paediatric SurgerySt George’s University Hospitals NHS Foundation, TrustLondonUK

Personalised recommendations