title: Challenges, successes and opportunities for reducing readmissions in a referral-based children's hospital NICU.
abstract: OBJECTIVE
  To evaluate readmission data in a level IV neonatal intensive care unit (NICU) to identify patient characteristics and process failures which serve as drivers for readmission.
  
  
  METHODS
  Our center is a primary referral center in Central and Southeast Ohio, providing us a unique opportunity to evaluate readmissions. We studied our current discharge process, caregiver perception of discharge readiness, parental comfort and the pre-discharge and post-discharge characteristics of infants.
  
  
  RESULTS
  Our readmission rate during the 4 year period has remained stable at 9.8%. 74% of the caregivers rated that their perception of their baby's medical readiness for discharge was good to excellent. Duration of hospitalization and public insurance coverage (Medicaid) were significant risk factors for readmission (p = 0.00). In our setting, the majority of the patients are readmitted through the emergency department and nearly half of all readmissions were for 3 or fewer days. Patients discharged from our Comprehensive Center for BPD had similar readmission rate despite characteristics which should increase their readmission rate.
  
  
  CONCLUSIONS
  Readmission rate is a poor indicator of the quality of care provided in the NICU. In addition to patient factors such as longer length of stay and Medicaid, our data suggests that preventing readmission depends on having systems in place to help families cope with transition of care after discharge.
authors.forename: R
authors.initials: R
authors.lastname: Bapat
authors.forename: R
authors.initials: R
authors.lastname: McClead
authors.forename: E
authors.initials: E
authors.lastname: Shepherd
authors.forename: G
authors.initials: G
authors.lastname: Ryshen
authors.forename: T
authors.initials: T
authors.lastname: Bartman
mesh_terms: D004636:Emergency Service, Hospital; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007231:Infant, Newborn; D007348:Insurance, Health / Q000706:statistics & numerical data; D007363:Intensive Care Units, Neonatal; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D009820:Ohio; D010290:Parents; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010465:Perception; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers; D014481:United States
keywords: Readmission; discharge process; quality improvement