Cardiomyopathy, single ventricle anatomy patients have highest unplanned readmission risk
In general, cardiac patients have one of the highest unplanned readmission rates (12%) after going home.
Patients with the heart muscle disease cardiomyopathy and those with single ventricle anatomy are most likely to have an unplanned readmission to the hospital within 30 days of their initial discharge, according to a study published in Pediatric Cardiology.
The study was led by cardiology fellow Michael He, MD, with support from pediatric cardiologists at Children’s National Hospital, including Ashraf Harahsheh, MD, who served as senior author.
What it means
The single center retrospective cohort study reviewed 1,848 hospitalizations that included 223 unplanned readmissions within 30 days of discharge. The authors sought to identify whether directly discharging patients from the Cardiac Intensive Care Unit (CICU) had an impact on readmissions. Typically, cardiac patients are “stepped down” to an acute care inpatient cardiology unit, the Heart and Kidney Unit (HKU) at Children’s National, prior to discharge. When census is high in the HKU, however, some patients can be sent home directly from the CICU.
The analysis showed no connection between CICU-based discharge or HKU-based discharge, but the authors found several other factors that made unplanned readmission more likely:
- Single ventricle anatomy
- Chromosomal anomaly
- Cardiomyopathy
- Tube feeding
- Increased length of initial stay
Why it matters
In general, cardiac patients have one of the highest unplanned readmission rates (12%) after going home. A deeper dive into the unplanned readmission rates for this group can help care providers identify gaps in discharge instructions and other areas for quality improvement initiatives. The overall goal for these studies is to identify ways to decrease return rates to the hospital for this fragile patient population.
What’s next
The study authors note that multi-center studies of unplanned readmissions would be beneficial to determine if these findings are limited to the specific population mix at Children’s National or if they are somewhat consistent across care centers.
They also recommend that quality improvement initiatives be targeted at patient groups with the highest risk of unplanned readmission, especially those with cardiomyopathy, single ventricle anatomy or those admitted for medical care. The lower unplanned readmission rates for surgical care patients may be due in part to decades of quality improvement initiatives and processes focused on surgical patients, the authors note. “Centers should strive to adapt these processes to medical admissions as well.”
Care providers should also take particular care when assessing discharge readiness and post discharge planning for patients requiring tube feeding and those with chromosomal abnormalities and syndromes, who also had higher risks for unplanned readmissions.
“Our study hopes to lay the foundation for both local and multi-center outcome initiatives to further better the health of our patients,” the authors write.
Read the full study, “Patient Characteristics Associated with 30-Day Readmission to a Pediatric Cardiac Center,” in Pediatric Cardiology.
Other authors from Children’s National include: Maria‑Theresa Balbin, Janet Kreutzer, Jenhao J. Cheng, Janika Peyasena, Lisa Hom, Mary Morgan, Tracy Baust and Yuliya Domnina, MD, medical director for quality and safety in the ICU.
