The burden, clinical characteristics and outcomes of children readmitted to the Pediatric wards at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: Readmission rate has been used as a measure of the quality of service offered in hospitals during preceding admissions. Some countries have put up measures to reduce excess readmissions. Readmissions occurring too soon after discharge are more likely to be avoidable. It has been documented that savings could be made by reducing potentially avoidable readmissions. Congestion at the paediatric wards in Moi Teaching and Referral Hospital (MTRH) would be improved by reducing these readmissions. This study describes the characteristics of these children in an attempt to identify the group at risk of being readmitted. Objectives: To determine the burden of readmission, clinical characteristics and outcomes of children readmitted to the paediatric wards at MTRH, Eldoret. Methods: This was a census conducted in the paediatric wards at MTRH between May 2015 and January 2016. The study population included all the children readmitted within 30 days of discharge from MTRH paediatric wards. Children with planned admissions were excluded. Data on socio-demographics and clinical characteristics was collected using a structured data collection form and analysed using STATA version 13. Categorical variables were summarised as frequencies and percentages while continuous variables were summarised as mean or median and the corresponding inter quartile range. Kruskal Wallis Test was used to test for association between age, sex, insurance, duration from discharge and diagnosis at readmission with the length of hospital stay. A p value < 0.05 was considered statistically significant. Results: During the study period 3067 children were discharged home and 130 of them were readmitted within 30 days of discharge making the readmission rate 4.2%. The females were 53.8%. Eighty seven percent of the children readmitted were in the age categories of less than 1 year and above 5 years. About 29% were readmitted within 7 days of discharge. Majority of the readmitted patients had pneumonia at 18.5%. Among the readmitted children below 5 years of age, 29.5% had severe acute malnutrition. Sixty seven percent of the readmitted children had an underlying chronic illness with congenital heart disease being the commonest at 16%. The median length of hospital stay was 7.5 (5-13) days. Mortality rate among the readmissions was 1.5%. Age, sex, medical insurance, duration from discharge and diagnosis at readmission was not significantly associated with the length of hospital stay. Conclusion: The readmission and mortality rates are low among children readmitted in the paediatrics wards at MTRH. Majority of the readmitted children at MTRH had pneumonia and underlying chronic illness. Recommendation: Children with pneumonia and those with chronic diseases should be followed up closely. We recommend a study to look at children who may die at home or are readmitted to other facilities after discharge from MTRH paediatric wards.