Winner Katherine, Sandberg Kelly, Saia Brandon, Calabro Megan, Blankenship Kelly
Wright State University Boonshoft School of Medicine, Dayton, Ohio.
Dayton Children's Hospital, Department of Behavioral Health, Dayton, Ohio.
Pediatrics. 2025 Feb 1;155(2). doi: 10.1542/peds.2023-064917.
Youth behavioral health inpatient beds are limited during a time of crisis. Around one-third of youth admitted to a behavioral health unit (BHU) will be readmitted within 1 year of discharge, with 8% to 13% being admitted within 30 days. In one study, they found that more than one-third of patients initially admitted for suicidal ideation or attempt were readmitted within 7 days. Our objective was to decrease 7-day and 30-day readmission rates to our BHU by 20% by May of 2023.
We collected baseline data through medical record review for our pediatric BHU readmissions from July 2020 until July 2021. Interventions, such as standardized workflows and checklists, were trialed with Plan-Do-Study-Act (PDSA) cycles beginning October 2021 until November 2022. Performance was analyzed using statistical process control charts (U-charts). Sustainment was tracked through December 2023. Length of stay (LOS) was tracked as a balancing measure. Compliance with our readmission checklist was tracked as a process measure.
Both 7-day and 30-day readmission rates to the pediatric BHU decreased as interventions were initiated and adopted. The rates of patients readmitted within 7 and 30 days decreased from a baseline mean of 5.54 to 2.83 (49%) and 11.52 to 7.38 (36%) per 100 hospitalizations, respectively. The LOS for the BHU decreased from 5.58 to 5.09 days. The readmission checklist was used for 81 out of 83 patients, or 97.5%.
Adoption of multiple interventions produced a decrease in readmissions to a pediatric BHU.
在危机时期，青少年行为健康住院床位有限。约三分之一入住行为健康科（BHU）的青少年在出院后1年内会再次入院，其中8%至13%在30天内再次入院。在一项研究中，他们发现最初因自杀意念或自杀未遂入院的患者中，超过三分之一在7天内再次入院。我们的目标是到2023年5月将BHU的7天和30天再入院率降低20%。
我们通过回顾2020年7月至2021年7月儿科BHU再入院患者的病历收集基线数据。从2021年10月开始至2022年11月，采用计划-执行-研究-行动（PDSA）循环对标准化工作流程和检查表等干预措施进行试验。使用统计过程控制图（U图）分析绩效。持续跟踪至2023年12月。住院时间（LOS）作为一项平衡指标进行跟踪。对再入院检查表的依从性作为一项过程指标进行跟踪。
随着干预措施的启动和采用，儿科BHU的7天和30天再入院率均下降。7天和30天内再次入院的患者比例分别从每100次住院的基线平均值5.54降至2.83（下降49%）和从11.52降至7.38（下降36%）。BHU的住院时间从5.58天降至5.09天。83例患者中有81例使用了再入院检查表，使用率为97.5%。
采用多种干预措施使儿科BHU的再入院率降低。
