Provider Feedback: A Potential Method to Reduce Readmissions

There is growing emphasis on improving hospital discharge planning and transitional care for children.1 Many of the potential elements, such as medication reconciliation, patient education, scheduling of outpatient follow-up visits, and postdischarge telephone or home nursing outreach, can be added or improved through process change and new resource allocation. In adult and elderly patients, poor quality-of-care transitions have been linked to higher readmission rates, and bundled transitional care interventions have decreased readmissions in these patients.2 There is less published evidence on the impact of such interventions in hospitalized children.3 The value of readmissions as a metric of pediatric hospital care quality and the potential impact of interventions aimed at improving hospital discharge remains in question.4–6 Despite this uncertainty, pediatric readmission metrics are being incorporated into quality and payment reform, which drives efforts to further understand the etiologies of pediatric readmissions.7 As part of a broader quality improvement initiative to reduce readmissions, we notified inpatient providers about their patients’ readmissions and sought their perceptions about the preventability and causes of readmissions. In this study, we analyzed their responses to describe (1) the preventability of 30-day readmissions, and (2) causes of potentially avoidable readmissions as judged by inpatient clinicians. ### Population and Setting This work occurred at Children’s Hospital Colorado, a free-standing tertiary care center with more than 20 000 hospital discharges per year. The project was performed by our readmissions team within the context of a national quality improvement collaborative.8 We developed a process of e-mail notification for providers of children with unplanned 30-day readmissions between June and December 2013. E-mails were sent to the discharging provider from the index admission and the readmitting provider. Children discharged from all hospital services and units were included. The project was approved as quality improvement by the Children’s Hospital Organizational Research …