More than half of parents and one-third of physicians felt children’s hospital readmissions could have been avoided, according to a new study. The findings prompted researchers to suggest better parent education and coordination of follow-up care could help lower readmission rates.
“We do need to work as a team to make this a smoother transition home, so the more we can share information not just with the family when they’re going home but also with the primary care provider that can really help smooth the transition,” said Dipti Amin, M.D., FAAP, lead author of the study “Parent and Physician Perceptions Regarding Preventability of Pediatric Readmissions” (Hosp Pediatr. Jan. 7, 2016, http://hosppeds.aappublications.org/content/6/2/80).A new study calls for better parent education before hospital discharge. AAP News photo by Jeff Knox
Hospital readmission rates are used to measure quality of care. Previous research has found a pediatric 30-day readmission rate of 6.5% and one-year readmission rate of 16.7%. To look more closely at these rates, researchers interviewed 60 parents of children who were readmitted to the hospital within 30 days of a previous stay, surveyed the physicians involved and reviewed the patients’ medical records.
The average patient was just over 6 years old, and nearly half had a chronic disease. On average, the patients had spent four to five days in the hospital and were readmitted about 10 days after discharge.
Nearly all parents and about 76% of physicians felt the child’s condition was serious upon readmission, while roughly 59% of parents and 36% of physicians said they felt the readmission could have been prevented, the study found. In addition, about 67% of parents and 75% of physicians felt the child was likely to end up in the hospital again.
When asked open-ended questions, some parents expressed concerns about the child’s discharge being rushed. Dr. Amin, a pediatric hospitalist and chief medical informatics officer at All Children’s Hospital in St. Petersburg, Fla., cited research showing readmission rates are lower when parents and physicians agree the child is healthy enough to be discharged.
Parents also said they need more education about how to help their child, making comments like “Come talk to me instead of giving me a bunch of papers to read.”
“For the parent, it was more about if I knew more, I could have done more,” Dr. Amin said.
Physicians agreed parents need more education. Dr. Amin suggested using a “teach-back” method in which parents share information they have learned about how to handle different scenarios so the physician can confirm they understand.
The study also found that roughly 19% of parents said they had trouble obtaining medications after discharge, and 21% had difficulty arranging a follow-up visit with a specialist. While most were told to follow up with their primary care physician, only 55% did so before their child was readmitted to the hospital.
In some cases, insurance and transportation were hurdles in accessing follow-up care. Dr. Amin suggested hospital staffs could do more to help patients in these areas and stressed communication with pediatricians.
“Once they go home, it’s the pediatrician that needs to take over, and they (hospital staff) need to have a good partnership with those pediatricians,” she said.