236. Reducing 30-day All Cause Readmission Rates After Elective Pediatric Neurosurgical Procedures. A Single-center Experience.

Authors: Jean-Paul Bryant; Jillian Larkin; Jason Stiles; Ana Diaz; Patricia Tavo; Ivette Roldan; Kari Bollerman; William Smit; Robert Hannan, MD; John Ragheb, MD (Miami, FL)

Introduction:

Preventable readmissions may provide an avoidable cost and psychological burden for parents and pediatric patients. In this Quality Improvement (QI) project we sought to understand the causes and solutions for the most common causes of elevated readmission rates in a single center experience of a pediatric neurosurgical department.

Methods:

A chart review was conducted on patients who underwent elective neurosurgical procedures between 2/1/2015 and 3/1/2018 that were readmitted within 30 days of operation. Demographics, readmission data, and neurosurgical procedure information were recorded to identify causes of increased readmission rates. Gemba walks were performed to assess discharge procedure and identify areas that could benefit from standardization.

Results:

89 patients underwent a neurosurgical operation and were subsequently readmitted within 30 days. The most common reason cited for unplanned readmissions was vomiting (n = 14), followed by fever (n=9), and seizures (n=9). Shunt malfunctions (n=8) and headaches (n=8) were also commonly cited reasons for readmission. 56% (n=9; total low-complexity readmissions=16) of patients that were classified as low-complexity readmissions were discharged on the weekend. 75% (n=12) of patients that were classified as low-complexity readmissions were on Medicaid. The Gemba walks revealed many procedural areas for improvement, including, standardization of discharge instructions and reduction in length of written discharge instructions.

Conclusion and Intervention:

The QI, nursing, and neurosurgical departments collaborated in creating a Quick Response (QR) Code for scanning with a mobile device. This code provides patients with condensed discharge instructions. Our data suggests that communication influences preventable readmissions. Our intervention will hopefully reduce recent elevations in readmission rates.