Study: Pediatric readmission rates don't reflect hospital quality

Hospital readmission rates for children with common pediatric conditions, such as asthma and pneumonia, are not meaningful measures of the quality of their care, according to a new UC San Francisco (UCSF) study.

The results, which will be published in the September issue of the journal Pediatrics, is the first multi-state study of children's and non-children's hospitals that assesses pediatric readmission rates, specifically those patients admitted to the hospital again or visiting the emergency room within 30 days of discharge.

Researchers used a multi-state database to analyze 958 large, medium and urban hospitals that admit children. The team calculated the rates of readmissions and revisits to the hospital for seven common inpatient pediatric conditions: asthma, dehydration, pneumonia, appendicitis, skin infections, mood disorders and epilepsy.

The research team determined the data doesn't indicate whether a hospital is better or worse than average. All of the hospitals in the study had 30-day readmission rates of less than 5 percent in all areas except for epilepsy (6.1 percent), dehydration (6 percent) and mood disorders (7.6 percent).

"As a national way of assessing and tracking hospital quality, pediatric readmissions and revisits, at least for specific diagnoses, are not useful to families trying to find a good hospital, nor to the hospitals trying to improve their pediatric care," said lead author Naomi Bardach, M.D., an assistant professor of pediatrics at UCSF Benioff Children's Hospital. "Measuring and reporting them publicly would waste limited hospital and healthcare resources."

One way hospitals can prevent pediatric readmissions is to reconsider their nursing staffing ratios, according to findings in a May study in the online journal BMJ Quality and Safety in Health Care and previously reported by FierceHealthcare.

That study examined common medical and surgical conditions, such as pneumonia and appendectomy, and pediatric readmissions. Researchers found an increase of only one patient in a hospital's average staffing ratio raised the likelihood of a medical patient's readmission within 15-30 days by 11 percent. But the odds of readmission for surgical patients increased by 48 percent.

Children treated in hospitals meeting a staffing benchmark of no more than four patients per nurse were significantly less likely to be readmitted within 15-30 days. Nursing staffing ratios had no effect on readmissions within the first 14 days after discharge.

"Lower patient-to-nurse ratios hold promise for reducing preventable readmissions by allowing for more effective pre-discharge monitoring of patient conditions, improving discharge preparation and through enhanced quality improvement success," Heather Tubbs-Cooley, Ph.D., a nurse scientist at Cincinnati Children's and the study's main author, said in the statement.

"Delivering high quality patient care requires nurses' time and attention, and better staffing conditions likely allow nurses to thoroughly complete the clinical care that children and their families need in order to have a successful discharge," she added.

For more:
-read the announcement about the study

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