What Factors Should Clinicians Focus on to Prevent Psychiatric Hospital Readmissions in Youth?

Longer length of initial stay, use of antipsychotics, proximity to the hospital, and comorbid obesity were among the risk factors of psychiatric inpatient readmission among youth in a retrospective review published in Psychiatry Research.

Corresponding author Eugene Grudnikoff, MD, of the department of psychiatry, Elmhurst Hospital in Queens, New York, led a retrospective review of consecutive pediatric admissions over the course of 1 year at a psychiatric hospital with 1 pre-adolescent unit (ages 5-12.9 years) and 3 adolescent units (ages 13-17.9 years).

Demographic and clinical variables were obtained from electronic medical record review, and the 30-day and 1-year readmission rates were calculated. The Family/Caregiver Interview Tool (FCIT) was administered to caregivers of patients readmitted within 30 days.  Stepwise elimination and multivariable logistic regression analyses were conducted to identify correlates of psychiatric readmissions. Additionally, FCIT variables were entered into a generalized linear model to identify environmental and family factors associated with readmission.  

During the survey year, 1233 youth (mean age, 14.6±2.7 years; 57.9% girls) experienced 1534 hospitalizations. While 768 patients were hospitalized once, 231 patients were re-hospitalized. The 30-day and 1-year readmission rates were 10.2% and 32.4%, respectively.

Per logistic regression, the factors significantly associated with 1-year re-hospitalization were residence outside of New York City (P <.0001), comorbid diagnosis of obesity (P =.010), greater length of hospital stay (P <.0001), and treatment with an antipsychotic medication at discharge (P <.0001), which altogether predicted 12.2% of the variance (P <.0001).

On the FCIT, 45.6% of caregivers indicated that they had felt that the child was not ready for discharge, 30.1% suggested that a longer stay would have prevented readmission, and 16.7% had trouble filling prescriptions after discharge. In a generalized linear model, caregiver ability to fill prescriptions delayed time to readmission (P <.0001), and paradoxically, shorter time from discharge to follow-up appointment was found to hasten time to readmission (P =.0077).

According to clinicians administering the FCIT, the root cause of readmission was illness-related in 73.2% of cases, while environment of care/family factors and systems of care factors each accounted for 13.4% of cases. Notably, clinicians and parents did not agree on root causes.

Overall, hospital readmissions appear to be common among youth with mental disorders and are associated with clear clinical and environmental factors. Limited data were available for participants with admissions at other hospitals and admissions prior to the survey year. As such, results should be extrapolated with care, particularly when considering those with high illness chronicity.

“Preventing psychiatric readmissions requires that the mental healthcare team attends to a broad range of illness-perpetuating or exacerbating factors,” the investigators wrote.

Reference

Grudnikoff E, McNeilly T, Babiss F. Correlates of psychiatric inpatient readmissions of children and adolescents with mental disorders [published online October 26, 2019]. Psychiatry Res. doi:10.1016/j.psychres.2019.112596