The Value of Efficient Discharge Policies for Pediatric Asthma

When patients are given comprehensive education, have medications in hand, and have a follow-up appointment scheduled at discharge, they’re less likely to be readmitted to the hospital.

Kavita Parikh, MD, MSHS

A new study confirms that robust discharge procedures can be a major factor in preventing return hospitalizations in children who are admitted for asthma attacks.

Researchers from Children’s National Health System, in Washington, DC, sought to identify factors that appeared to lower the risk of a child being readmitted within the 12 months following an asthma exacerbation.

Lead author Kavita Parikh, MD, MSHS, an associate professor of pediatrics at Children’s National, told MD Magazine that a large majority (4 out of 5) hospital readmissions after index admissions for asthma are considered “potentially preventable.”

“In this study, we sought to describe current hospital-based, asthma-specific discharge components at children’s hospitals and determine the association between these discharge components with pediatric asthma readmissions,” Parikh said. “Our hope is to identify something that hospitals can do at the time of discharge to prevent a future ED visit or hospitalization for an asthma exacerbation.”

Parikh and colleagues used data from 45 hospitals in their study, focusing on admissions for children ages 5 to 17, who were admitted due to acute asthma exacerbation in 2015. The hospitals had a median of 349 asthma discharges that year. Within 30 days, an average of 2.6% of patients were readmitted to the hospital; when the time horizon was stretched to 3 months, the readmission rate was 6.6%.

In three-quarters of the cases (76%), patients received asthma education services at discharge, making it the most common discharge component. In two-thirds of cases (67%), patients received spacers, and in 58% of cases the patient’s primary care physician was contacted.

The good news is that education, sending home devices like spacers, and primary care physician contact were all associated with lower readmission rates, according to the data. However, the researchers found other, less common, discharge practices are also important. They found that giving parents medications like controller medications and oral steroids helped lower readmission rates.

So, too, did actually scheduling appointments with the primary care doctor, in addition to simply communicating with the doctor. Finally, post-visit activities like home visits and referrals for environmental mitigation programs helped narrow the likelihood of readmission.

In other words, the more comprehensive the discharge policies, the better. Parikh said she hopes this information helps hospitals focus on what works and what’s most feasible.

“I think that as a healthcare system, hospitals need to be proactive to ensure a safe hospital-to-home transition for the patients who they serve,” Parikh said. “But, of course, we want to direct our hospital resources to efforts that will work to help asthma care management outside of the hospital.”

One good place to start would be sending home medications, instead of just a prescription slip, Parikh said.

“We know that being in the hospital is disruptive to the family, and stopping at an outside pharmacy after discharge to pick up prescriptions can be challenging,” she said. “One possibility is that hospitals can facilitate getting these medications in the hands of the family at discharge, which also would provide opportunities to teach families about their home medications.”

The study, “Impact of Discharge Components on Readmission Rates for Children Hospitalized with Asthma,” was published online in the Journal of Pediatrics this month.

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