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Children's Mercy Kansas City Children's Mercy Kansas City
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Presentations
2019
Screening Pediatric Patients for Readmission Risk Screening Pediatric Patients for Readmission Risk
Sarah Bradshaw Children's Mercy Hospital, [email protected]
Blair Buenning Children's Mercy Hospital, [email protected]
Anita Powell Children's Mercy Hospital
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Recommended Citation Recommended Citation Bradshaw, Sarah; Buenning, Blair; and Powell, Anita, "Screening Pediatric Patients for Readmission Risk" (2019). Presentations. 24. https://scholarlyexchange.childrensmercy.org/presentations/24
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© The Children's Mercy Hospital 2017
Screening Pediatric Patients
for Readmission Risk
1
Sarah Bradshaw, MSN, RN, CPN, ACM-RN
Blair Buenning, MSN, RN, CPN, ACM-RN
Anita Powell, MA, BSN, RN, BC, ACM-RN
Experts in Pediatric Care
• Nearly 8,000 employees
• 750+ pediatric specialists
• 2,200 nurses
• 1,000+ allied health
professionals
• More than 900 volunteers
2
Our Locations
3
The Highest Level of
Care for Kids• 40+ pediatric specialty areas
• Highest level pediatric trauma center
• Highest level neonatal intensive care unit
• Ranked among the best children’s
hospitals in the country by US News
• Honored by the Magnet® Recognition
Program for excellence in nursing
• Leader in pediatric research & innovation
4
Hospital Acquired Conditions• Preventable Readmissions
• Central Line-Associated Blood Stream Infections (CLABSI)
• Catheter-Associated Urinary Tract Infections (CAUTI)
• Serious Falls
• Pressure Injury
• Surgical Site Infections
• Venous Thromboembolism
• Adverse Drug Events (ADE)
5
Pediatric Readmission Costs
• Cost per event1= $9,540
• Average yearly Medicaid claim for single complex patient = $69,906
• Nationwide annual cost (2015) = $1.5 Billion
6
Pediatric Readmission Costs
• Health Risk to Patients (HACs)
• Family Inconvenience
• Unnecessary use of hospital resources
7
Case Management Standard of Care
8
Screening/ Identification
Through use of identification criteria, stratify patients at risk
AssessmentExpand on knowledge gained by screen and complementary to other disciplines’ assessements
“Case management is expected to have a defined method for
screening/identification and assessment of patients in need of case
management services”
Screening for Readmission Risk
9
Adult Screen Tools
Modified LACE Tool
Pra Risk Tool
Cerner’s readmission stratification score
HOSPITAL Score
Pediatric Screen Tools
Why Develop a Screen tool?
DecreaseReadmissions
Length of Stay
Emergency Department visits
IncreasePatient/family satisfaction with care
Compliance with national standards of practice & CMS regulations
Literature Review
➢Identified pediatric risk factors
➢Developed tool based on findings
➢Validated need for tool to look at multiple
factors, not just admitting diagnosis
Identified Risk Factors
Admitting Diagnosis
Chronic Condition Indicator
Readmission History
Admission Acuity
Insurance
DME Home Nursing Home Therapy Language
Cycle of QI and ResearchIdentify
the Need
Literature Review
QI
ResearchEvaluation of Results
Formulate plan
Apply next steps
Gaps Addressed in QI Cycles
14
Validity
RELIABILITY of data
Evidence based practice
Lack of documentation/data points available
QI Project Measures
Outcome100% of admitted
patients will have a screen complete within 24 hours of admission
Process>85% reliability between
Care Managers
Decrease average completion time
100% of fields completed within each
entry
BalancingNurse Care Manager
satisfaction
30-day readmission rate
Identifying How To Change
1. What are we trying to accomplish?
2. How will we know that a change resulted
in improvement?
3. What change could we make that might
result in improvement?
Plan – Do – Study - Act
17
Implement Tool
Cycle 1
Decrease variability
Cycle 2Focus on
missed populations
Cycle 3
Modify tool
Cycle 4Sustain
results
Cycle 5
Final Control Chart
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Co
mp
leti
on
Rate
Time
HARRPS Tool Completion Rate within 24 Hours of Admission -Overall Data
Sustaining Improvements
Post QI Next Steps → Research
Produce and share
generalizable knowledge
Cross validate findings
Test HARRPS validity and predictive ability in
identifying pediatric
readmission risk
Obtain Institutional
Review Board (IRB) Approval
HARRPS Tool
21
Research Overview
Evaluate
Evaluate each category of tool for validity and reliability
Associate
Associate scores based on statistical findings
Combine
Combine scores to produce a total
Identify
Identify high, moderate, and low risk scores
Validate
Cross validate findings
Identified Risk Factors
Admitting Diagnosis
Chronic Condition Indicator
Readmission History
Admission Acuity
Insurance
DME Home Nursing Home Therapy Language
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
10%
PR
EV
AL
EN
CE
Admission Diagnosis
Control Group 30-Day Readmission
<0.0001 <0.0001
* p-value
0%
10%
20%
30%
40%
50%
60%
0 1 2 3 4+
PR
EV
AL
EN
CE
Chronic Condition Indicator
Control Group 30-Day Readmission
* p-value
<0.0001 0.3517 <0.0001 <0.0001 <0.0001
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Readmitted within 30 days Inpatient Admit in last 6 months
PR
EV
AL
EN
CE
Readmission History
Control Group 30-Day Readmission
* p-value
<0.0001 <0.0001
0%
10%
20%
30%
40%
50%
60%
70%
80%
ICN/PICU Admission Significantpsychosocial concern
Medical transport fromoutside facility
No admission acuityidentified
PR
EV
AL
EN
CE
Admission Acuity
Control Group 30-Day Readmission
* p-value
<0.0001 0.1118 0.1971 <0.0001
0%
10%
20%
30%
40%
50%
60%
70%
Self Pay Medicaid Commercial/Private
PR
EV
AL
EN
CE
Insurance Type
Control Group 30-Day Readmission
* p-value
0.4303 <0.0001 <0.0001
0%
2%
4%
6%
8%
10%
12%
14%
1 2 3 4+
PR
EV
AL
EN
CE
Medical Equipment Count
Control Group 30-Day Readmission
* p-value
0.163 <0.0001 <0.0001 <0.0001
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
Private Duty Nursing Skilled Nursing
PR
EV
AL
EN
CE
Home Nursing
Control Group 30-Day Readmission
* p-value
<0.0001 <0.0001
0%
1%
2%
3%
4%
5%
6%
Home Occupational Therapy Home Physical Therapy Home Speech Therapy
PR
EV
AL
EN
CE
Home Therapy
Control Group 30-Day Readmission
* p-value
<0.0001 <0.0001 <0.0001
Caregiver Language
Associate Scores
1Admitting Diagnosis
3Chronic Condition
Indicator
2Readmission
History
1Admission Acuity
1Insurance
4DME
1Home Nursing
1Home Therapy
0Language
Identify High Risk Score
Identify Risk Score Cut PointsRisk score 14: Excluded from analysis due to only
having 4 out of 5371 samples
Cross Validate Findings
C-Statistic Score compared to
Adult Risk Tools
HARRPS
0.68
Modified
LACE
0.63
Cerner’s
Adult
readmission
calculation
0.69
Pra Risk
Tool
0.65
HOSPTIAL
Score
0.76
Timeline
Investigation of current risk tools
Literature Reviews & Initial Build
Quality Improvement Project
Research Project
Data Review and Tool Finalization
Tool Dissemination
Fall
2015
Spring
2016
Fall
2016
May 2017-
June 2018
Summer
2018
2019 &
Beyond
Future Implications
What innovative opportunities do we have at Children's Mercy, and through SPS to utilize HARRPS Tool
readmission risk findings?
Questions? Please contact [email protected]
