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Reducing readmissions following paediatric cardiothoracic surgery: a quality improvement initiative

Published online by Cambridge University Press:  13 August 2014

Brian Kogon*
Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, United States of America
Kim Woodall
Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, United States of America
Kirk Kanter
Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, United States of America
Bahaaldin Alsoufi
Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, United States of America
Matt Oster
Sibley Heart Center Cardiology, Children’s Healthcare of Atlanta, Atlanta, Georgia, United States of America
Correspondence to: B. E. Kogon, Department of Cardiothoracic Surgery, Emory University, Children’s Healthcare of Atlanta, 1450 Clifton Road NE, Atlanta, GA 30033, United States of America. Tel: +404 785 6319; Fax: +404 785 6266; Email:


Background: We have previously identified risk factors for readmission following congenital heart surgery – Hispanic ethnicity, failure to thrive, and original hospital stay more than 10 days. As part of a quality initiative, changes were made to the discharge process in hopes of reducing the impact. All discharges were carried out with an interpreter, medications were delivered to the hospital before discharge, and phone calls were made to families within 72 hours following discharge. We hypothesised that these changes would decrease readmissions. Methods: The current cohort of 635 patients underwent surgery in 2012. Demographic, preoperative, operative, and postoperative variables were evaluated. Univariate and multivariate risk factor analyses were performed. Comparisons were made between the initial (2009) and the current (2012) cohorts. Results: There were 86 readmissions of 77 patients during 2012. Multivariate risk factors for readmission were risk adjustment for congenital heart surgery score and initial hospital stay >10 days. In comparing 2009 with 2012, the overall readmission rate was similar (10 versus 12%, p=0.27). Although there were slight decreases in the 2012 readmissions for those patients with Hispanic ethnicity (18 versus 16%, p=0.79), failure to thrive (23 versus 17%, p=0.49), and initial hospital stay >10 days (22 versus 20%, p=0.63), they were not statistically significant. Conclusions: Potential risk factors for readmission following paediatric cardiothoracic surgery have been identified. Although targeted modifications in discharge processes can be made, they may not reduce readmissions. Efforts should continue to identify modifiable factors that can reduce the negative impact of hospital readmissions.

Original Articles
© Cambridge University Press 2014 

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