Bapat R, McClead R, Shepherd E, Ryshen G, Bartman T
J Neonatal Perinatal Med. 2016;9(4):433-440. doi: 10.3233/NPM-161624.
To evaluate readmission data in a level IV neonatal intensive care unit (NICU) to identify patient characteristics and process failures which serve as drivers for readmission.
Our center is a primary referral center in Central and Southeast Ohio, providing us a unique opportunity to evaluate readmissions. We studied our current discharge process, caregiver perception of discharge readiness, parental comfort and the pre-discharge and post-discharge characteristics of infants.
Our readmission rate during the 4 year period has remained stable at 9.8%. 74% of the caregivers rated that their perception of their baby's medical readiness for discharge was good to excellent. Duration of hospitalization and public insurance coverage (Medicaid) were significant risk factors for readmission (p = 0.00). In our setting, the majority of the patients are readmitted through the emergency department and nearly half of all readmissions were for 3 or fewer days. Patients discharged from our Comprehensive Center for BPD had similar readmission rate despite characteristics which should increase their readmission rate.
Readmission rate is a poor indicator of the quality of care provided in the NICU. In addition to patient factors such as longer length of stay and Medicaid, our data suggests that preventing readmission depends on having systems in place to help families cope with transition of care after discharge.
评估四级新生儿重症监护病房（NICU）的再入院数据，以确定作为再入院驱动因素的患者特征和流程失误。
我们的中心是俄亥俄州中部和东南部的主要转诊中心，这为我们评估再入院情况提供了独特的机会。我们研究了当前的出院流程、护理人员对出院准备情况的看法、家长的舒适度以及婴儿出院前和出院后的特征。
在4年期间，我们的再入院率一直稳定在9.8%。74%的护理人员认为他们对宝宝出院时的医疗准备情况的看法为良好至优秀。住院时间和公共保险覆盖范围（医疗补助）是再入院的重要风险因素（p = 0.00）。在我们的环境中，大多数患者通过急诊科再次入院，并且所有再入院患者中近一半的再入院时间为3天或更短。尽管有一些特征表明应该会增加再入院率，但从我们的慢性肺病综合中心出院的患者的再入院率相似。
再入院率并不能很好地反映NICU提供的护理质量。除了住院时间较长和医疗补助等患者因素外，我们的数据表明，预防再入院取决于建立相应系统，以帮助家庭应对出院后的护理过渡。
