1 in 5 Pediatric Epilepsy Readmissions Preventable

Marissa Vawter-Lee, MD

While 1 in 5 pediatric epilepsy readmissions were scheduled, an additional 20% were judged to be preventable, according to a new report.

An interdisciplinary team from the Cincinnati Children’s Hospital Medical Center was established to review and characterize 30-day readmissions from patients admitted for epilepsy between May 2014 and October 2016. The team was made up of inpatient and outpatient neuroscience nurses, care managers, a quality outcomes manager, and child neurology physicians who individually reviewed the data.

“There was no prior data of this sort, so we were not sure what we were going to find when we started the study,” study author Marissa Vawter-Lee, MD told MD Magazine®. Other studies had found that pediatric epilepsy readmission rates hovered around 6-10% but they did not describe the readmitted patients.

The investigators determined there was an all-cause 30-day readmission rate of 8.0% during the study period, which included 219 pediatric epilepsy readmissions from 169 patients, they said. Of those readmissions:

• 21.5% were scheduled
• 37% were for progression of chronic epilepsy
• 9.6% were for recently diagnosed epilepsy
• 14.6% were for unrelated diagnoses.

The investigators classified 21.5% of the readmissions as “preventable” and 64.9% as not preventable. The most common preventable causes for readmissions were problems with the discharge care plan or medication management, the study authors said.

“Prior to this study we thought the discharge paperwork looked fairly good, but once we started to focus on why patients were being readmitted and looked at their initial paperwork, there were clear problems,” Vawter-Lee continued. “The instructions for what to do at home weren’t always clear. The language was sometimes confusing with too much medical jargon. Paperwork didn’t always have what we would call a ‘rescue plan’ for what parents could and should do if seizures reoccurred once at home. We weren’t empowering parents to know what they could do at home if problems reoccurred, so that they could safely stay at home.”

A third of the readmissions occurred within a week of the initial hospital discharge, the investigators found. That included 61.7% of the “preventable” readmissions.

After analyzing these patterns of reasons for readmission, the hospital staff made changes. They hired an education specialist in the hospital whose job it is to approve discharge templates and ensure that wording is clear and understandable for patients and their parents.

“We have worked hard to improve our discharge process so parents are empowered and confident, the medications are available and parents understand them, and so discharge paperwork is understandable with a clear rescue plan for parents,” Vawter-Lee said. “As a result of this study we have improved our discharge process not just for seizure patients, but for patients admitted to the neurology service for any reason, such as headaches, tone issues, or gait issues. We make sure every parent knows what to do if things worsen or change when they get home.”

The study authors acknowledged that the process of this review may have impacted or influenced practice patterns, since neurology staff was aware that the readmissions were under review. However, they were able to demonstrate that all readmission rates before and during the study period stayed within the confidence limits. Without this study, they said, it is possible that readmission rates could have been worse, if providers practiced more conservatively knowing there were more eyes on readmission rates.

The paper, “Pediatric Epilepsy Readmissions: The Who, When, and Why,” was published in Pediatric Neurology.