Abstract 4147593: Improving Pediatric Heart Failure 30-Day Readmission Rates

Introduction: Pediatric heart failure (HF) 30-Day readmission rates are high (~20%) and contribute to resource utilization. Methods: A quality improvement project was initiated with the aim to reduce the pediatric HF 30-day readmission rate from above 20% to below 10% through utilization of four primary key drivers; Family directed self-care through variable diuretic dosing, early HF hospitalization follow-up, obtaining guideline directed medical therapy, and addressing iron deficiency in the hospital. Patients 18 years of age and younger admitted to the hospital with symptomatic systolic or combined (systolic and diastolic) HF were included. HF patients that were discharged after transplant or with ventricular assist device support were excluded. Electronic Health Record (EHR)-based interventions, including implementation of a HF discharge checklist, were used to deliver care and track key datapoints. Results: Since implementing the project on January 1, 2023, the HF 30-day readmission rate within our facility improved from 22% to 10%. The percentage of patients discharged with variable diuretic dosing plans is currently 50%. Patients discharged on at least three of five classes of HF medications increased from 75% to 80%. The percentage of patients that received early HF hospitalization follow-up decreased. Patients with iron assessed during their HF admission increased from 25% to 80%, and those with iron deficiency who received appropriate treatment increased from 75% to 100%. Summary: Pediatric HF 30-day readmission rates can be improved through EHR-based interventions using evidence-based adult heart failure practices. This was achieved despite the heterogeneity and lack of randomized trials in pediatric HF. Continuing efforts will focus on improving early HF hospitalization follow-up.