Use of a Discharge Confidence Assessment Tool to Reduce Pediatric Readmissions

This submission has open access
Submission ID :
ESPR225
Submission Type
Abstract: :

Background:

Readmission rates are used as an indicator of care received during a hospitalization. Average monthly unplanned readmission rate at Maria Fareri Children's Hospital (MFCH) in 2016 was 8.19%, with a high of 11.0% in December 2016. Multiple initiatives focused on discharge communication were implemented which led to a decrease in unplanned readmission rates to 8.08% in 2017 and 6.46% in 2018. In 2017, MFCH joined a multi-center collaborative aimed at improving the patient experience and reducing readmissions. In 2019, the collaborative developed a specific question assessing parental confidence at discharge. Details regarding when, by whom, and how the question would be asked were decided at the individual site level. 

Objective:

To evaluate whether assessing parent confidence at discharge, using a simple Discharge Confidence Assessment Tool (DCAT), will decrease unplanned 30-day readmission rates to less than 6.0%, a benchmark established by the collaborative.

Design/Methods:

The DCAT was implemented in July 2019 on four general pediatric inpatient units. Nurses were instructed to ask the question at time of discharge (Figure 1). If a score was less than 5, an attempt was made to address concerns. Unplanned readmission rates for MFCH were tracked throughout the study period. Retrospective data was collected from April - July 2020, including percent of patients discharged from the study units for whom the DCAT was completed, DCAT response scores, and unplanned readmission rates. 

Results:

Monthly unplanned readmission rates decreased to a low of 3.7% in October 2019, shifting the median centerline down to 4.2% which was a 47.5% reduction from baseline and surpassing our goal (Figure 2). A sub-analysis of data from April - July 2020 on the four units where the DCAT was implemented showed that 98% of patients discharged had a DCAT completed. The average unplanned readmission rate for patients with a completed DCAT was 4.5%, which was 33% lower than the rest of the children's hospital (6.72%). For all patients who had the DCAT completed, 99% scored a 5 on the DCAT. Of the patients with unplanned readmissions, all scored a 5. 

Conclusions: Assessment of parental confidence via a simple discharge confidence assessment at the time of discharge was associated with a decrease in unplanned readmission rates. There was no association between the Likert-scale score and readmission rate. Feedback from nursing indicated the DCAT was not overly burdensome. Notably, the overall hospital readmission rate appeared to be up trending towards the end of the study period. Review of individual cases suggests that limited follow-up during a concurrent global pandemic may have contributed to this trend. Further studies are needed to evaluate timing and wording of the question to enhance responses and whether widespread implementation will show sustained improvement.

Optional insertion of tables and or figures :
If the file does not load, click here to open/download the file.
If the file does not load, click here to open/download the file.
New York Medical College
New York Medical College
New York Medical College
New York Medical College
Westchester Medical Center
Westchester Medical Center
Westchester Medical Center
New York Medical College

Similar Abstracts by Type

Submission ID
Submission Title
Submission Topic
Submission Type
Corresponding Author
ESPR157
Clinical Research
Original science
Aditya Chhikara
ESPR302
Epidemiology
Original science
Natasha Jouk
ESPR74
Clinical Research
Original science
Alexandra Mazo