title: Pediatric cardiac readmissions: An opportunity for quality improvement?
abstract: OBJECTIVE
  Hospital readmissions are increasingly becoming a metric for quality in the current landscape of changing and cost effective medicine. However, no 30-d readmission rates have been established for pediatric cardiac medical patients in the United States. Thus, the objective was to determine 30 d readmission rates and risk factors associated with readmission for pediatric cardiac patients, hypothesizing that pediatric cardiac patients would have significantly higher readmission rates than their general pediatric counterparts.
  
  
  METHODS
  This was a retrospective cohort study.
  
  
  METHODS
  The study took place at a large urban academic children's hospital.
  
  
  METHODS
  The 1124 included patients were discharged from the medical cardiology service and had an unplanned readmission within 30 d during the period of 2012-2014.
  
  
  METHODS
  Admissions, readmissions, diagnoses, demographics, weights, medications, procedures, length of stay, were all measured.
  
  
  RESULTS
  There were 1993 visits and 408 (20.5%) 30-d readmissions in our study. Among the 1124 patients, 219 (19.5%) had at least one 30-d readmission. Patient factors associated with increased likelihood of 30-d readmission were younger age (median: 197.5 vs 1365.5 d, P < .0001), lower discharge weight (6.2 v 14.5 kg, P < .0001) and greater number of diagnoses (P < .0001). The encounter factor associated with a 30-d readmission was longer length of stay (4 vs 2 d, P < 0.0001). Factors associated with decreased readmissions were having had an electrophysiology procedure during their stay, taking an angiotensin converting enzyme inhibitor/angiotensin receptor blocker or taking an antibiotic.
  
  
  CONCLUSIONS
  Readmissions within 30 d among pediatric cardiology patients are common. The most common factors associated with readmissions are not likely to be modifiable but may serve as important prognostic indicators and as a basis for counseling.
authors.affiliation: Children's Healthcare of Atlanta, Atlanta, GA, USA.|Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Sacks
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Kelleman
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Courtney
authors.initials: C
authors.lastname: McCracken
authors.affiliation: Children's Healthcare of Atlanta, Atlanta, GA, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Glanville
authors.affiliation: Children's Healthcare of Atlanta, Atlanta, GA, USA.|Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Oster
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000628:therapy*; D006776:Hospitals, Pediatric / Q000592:standards*; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000639:trends; D008297:Male; D010351:Patient Discharge / Q000639:trends; D010359:Patient Readmission / Q000639:trends*; D058996:Quality Improvement; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States
keywords: cardiology; hospital readmissions; outcomes; quality improvement