Abstract
BACKGROUND
Pediatric readmissions and postdischarge emergency department (ED) visits are common measures of postdischarge use and vary across pediatric conditions. Although often studied separately, these outcomes represent a continuum of hospital reuse. We introduce the ED/READ ratio (the ratio of postdischarge ED visits to readmissions) to characterize diagnosis-specific patterns of hospital reuse across common pediatric conditions.
METHODS
In this single-center retrospective cohort study, we included children aged 0 to 17 years discharged from an urban tertiary children’s hospital between July 2016 and December 2019. We included primary All-Patient Refined Diagnosis-Related Groups comprising 1% or more of admissions. The primary outcome was the 30-day ED/READ ratio, calculated as the number of all-cause postdischarge ED visits divided by the number of all-cause readmissions within 30 days of discharge, computed for each diagnosis with 95% CIs.
RESULTS
Among 16 518 hospitalizations from 11 728 patients, the overall 30-day postdischarge ED visit rate was 8.1% and the readmission rate was 9.2%. The 30-day ED/READ ratio ranged from 0.08 (95% CI, 0.05–0.12) for chemotherapy to 2.41 (95% CI, 1.50–3.33) for tonsil and adenoid procedures. Diagnoses with ratios significantly more than 1 included asthma, bronchiolitis and respiratory syncytial virus pneumonia, and gastroenteritis; ratios less than 1 included chemotherapy, sickle cell anemia crisis, and seizures.
CONCLUSION
The ED/READ ratio is a descriptive metric that complements traditional measures by characterizing diagnosis-specific patterns of postdischarge reuse across care settings. Used alongside existing metrics, the ratio may help generate hypotheses about diagnosis-specific targets for improvement. Further research is needed to evaluate its reproducibility and applications across diverse settings.