Readmission rates at three months for kids hospitalised for
acute asthma dropped when families received comprehensive education prior to
discharge, the only single component of discharge bundles that was strongly
associated with lowered readmissions, finds a multicentre retrospective cohort
study published online in The
Journal of Pediatrics.
Children who are hospitalised for asthma have a roughly 20%
chance of returning to the hospital in the next year, and individual
hospital readmission rates can range from 5.7% to 9.% at three months,
writes the study team.
“Improving how we care for children who are hospitalised
with asthma includes preparing them for a successful return home with the best
tools to manage their illness and prevent a future hospital visit,” says Kavita
Parikh, MD, MSH.S, an associate professor of paediatrics at Children’s National
Health System and lead study author. “Our study underscores the importance
of increasing the intensity of select discharge components. For example, ensuring
that children hospitalised for asthma receive asthma medication at
discharge along with comprehensive education and environmental mitigation may
reduce asthma readmissions.”
The study team analysed records from a national sample of
tertiary care children’s hospitals, looking at hospitalisations of 5- to
17-year-olds for acute asthma exacerbation during the 2015 calendar
year. They characterised how frequently hospitals used 13 separate asthma
discharge components by distributing an electronic survey to quality leaders.
Forty-five of 49 hospitals (92%) completed the survey.
The 45 hospitals recorded a median of 349 asthma discharges
per year and had a median adjusted readmission rate of 2.6% at 30 days and a
6.6% median adjusted readmission rate at three months. The most commonly used
discharge components employed for children with asthma were having a dedicated
person providing education (76%), providing a spacer at discharge (67%) and
communicating with a primary medical doctor (58%).
Discharge components that were trending toward reduced readmission
rates at three months include:
Comprehensive asthma education, including having
dedicated asthma educators
Medications and devices provided to patients at
discharge, such as spacers, beta-agonists, controller medication and oral
Communication and scheduled appointments with a
primary medical doctor
Post-discharge activities, including home visits
and referrals for environmental mitigation programmes.
“Connecting the family with a primary care provider and
oral steroids at discharge helps to improve patients’ timely access to care if
symptoms recur when they return home,” Dr Parikh adds. “Bundling
these discharge components may offer multiple opportunities to
educate patients and families and to employ a range of communication styles
such as didactic, visual and interactive.”
Parikh et al. Impact of Discharge Components on Readmission Rates for Children
Hospitalized with Asthma, The Journal of Pediatrics (2018). Published
online 1 February 2018.