Pediatric hospital discharge interventions to reduce subsequent utilization: a systematic review.

TitlePediatric hospital discharge interventions to reduce subsequent utilization: a systematic review.
Publication TypeJournal Article
Year of Publication2014
AuthorsAuger KA, Kenyon CC, Feudtner C, Davis MM
JournalJ Hosp Med
Volume9
Issue4
Pagination251-60
Date Published2014 Apr
ISSN1553-5606
KeywordsEmergency Service, Hospital, Hospitals, Pediatric, Humans, Outcome and Process Assessment (Health Care), Patient Discharge, Patient Education as Topic, Patient Participation, Patient Readmission, Quality of Health Care
Abstract

BACKGROUND: Reducing avoidable readmission and posthospitalization emergency department (ED) utilization has become a focus of quality-of-care measures and initiatives. For pediatric patients, no systematic efforts have assessed the evidence for interventions to reduce these events.

PURPOSE: We sought to synthesize existing evidence on pediatric discharge practices and interventions to reduce hospital readmission and posthospitalization ED utilization.

DATA SOURCES: PubMed and the Cumulative Index to Nursing and Allied Health Literature.

STUDY SELECTION: Studies available in English involving pediatric inpatient discharge interventions with at least 1 outcome of interest were included.

DATA EXTRACTION: We utilized a modified Cochrane Good Practice data extraction tool and assessed study quality with the Downs and Black tool.

DATA SYNTHESIS: Our search identified a total of 1296 studies, 14 of which met full inclusion criteria. All included studies examined multifaceted discharge interventions initiated in the inpatient setting. Overall, 2 studies demonstrated statistically significant reductions in both readmissions and subsequent ED visits, 4 studies demonstrated statistically significant reductions in either readmissions or ED visits, and 2 studies found statistically significant increases in subsequent utilization. Several studies were not sufficiently powered to detect changes in either subsequent utilization outcome measure.

CONCLUSIONS: Interventions that demonstrated reductions in subsequent utilization targeted children with specific chronic conditions, providing enhanced inpatient feedback and education reinforced with postdischarge support. Interventions seeking to reduce subsequent utilization should identify an individual or team to assume responsibility for the inpatient-to-outpatient transition and offer ongoing support to the family via telephone or home visitation following discharge.

DOI10.1002/jhm.2134
Alternate JournalJ Hosp Med
PubMed ID24357528