Pediatric hospital discharge interventions to reduce subsequent utilization: a systematic review.

BACKGROUND: Reducing avoidable readmission and posthospitalization emergency department (ED) utilization has become a focus of quality-of-care measures and initiatives. For pediatric patients, no systematic efforts have assessed the evidence for interventions to reduce these events.
PURPOSE: We sought to synthesize existing evidence on pediatric discharge practices and interventions to reduce hospital readmission and posthospitalization ED utilization. DATA SOURCES: PubMed and the Cumulative Index to Nursing and Allied Health Literature. STUDY SELECTION: Studies available in English involving pediatric inpatient discharge interventions with at least 1 outcome of interest were included. DATA EXTRACTION: We utilized a modified Cochrane Good Practice data extraction tool and assessed study quality with the Downs and Black tool. DATA SYNTHESIS: Our search identified a total of 1296 studies, 14 of which met full inclusion criteria. All included studies examined multifaceted discharge interventions initiated in the inpatient setting. Overall, 2 studies demonstrated statistically significant reductions in both readmissions and subsequent ED visits, 4 studies demonstrated statistically significant reductions in either readmissions or ED visits, and 2 studies found statistically significant increases in subsequent utilization. Several studies were not sufficiently powered to detect changes in either subsequent utilization outcome measure.
CONCLUSIONS: Interventions that demonstrated reductions in subsequent utilization targeted children with specific chronic conditions, providing enhanced inpatient feedback and education reinforced with postdischarge support. Interventions seeking to reduce subsequent utilization should identify an individual or team to assume responsibility for the inpatient-to-outpatient transition and offer ongoing support to the family via telephone or home visitation following discharge.