Multi-modal intervention and prospective implementation of standardized sickle cell pain admission orders reduces 30-day readmission rate

Abstract

Introduction: The National Association of Children's Hospitals (NACHRI) and the Centers for Medicare and Medicaid Services (CMS) recently introduced 30-day hospital readmission rate as a quality care indicator in children with sickle cell disease (SCD). Based on previous research identifying risk factors for 30-day readmission in our patient population, we designed and implemented a multi-modal intervention to reduce 30-day readmission rate in children with SCD and pain.

Methods: A before-and-after study design was performed to evaluate an intervention containing three components: (1) standardized SCD-pain admission orders; (2) monthly SCD-pain in-service for house physicians for the first 6-months; and (3) continuous patient/caregiver education. Following order implementation, we prospectively collected data on all children admitted for SCD-pain over a 6-month period. We compared the 30-day readmission rate after the intervention to the rate during the same 6-month interval in the previous calendar year prior to the availability of pre-specified SCD-pain orders.

Results: A total of 89 admissions, in 68 individuals, were eligible for the standardized orders during the prospective time period and were compared to 85 admissions in 56 individuals during the control period. Pre-specified SCD-pain orders were used in 93% of eligible admissions during the intervention. Readmission rate within 30 days was lower for the intervention cohort than the control cohort, 11% (10/89) versus 28% (24/85), P = 0.007, 95% CI 0.1-0.7.

Conclusions: A multi-modal intervention was successful in decreasing 30-day hospital readmission rate for children with SCD and pain. Provider education was the most important component of the multi-modal intervention.

Figure 1

Monthly 30-day readmission rate (%) for the intervention and control cohorts (July 2006-June 2007 vs July 2007–June 2008).