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Background: Infants with congenital heart disease (CHD) require continued and complex care in the first year of life, including regularly scheduled clinic visits. Unfortunately, given the high-risk nature of these patients, care also frequently includes hospital readmission which contributes to a high level of burden on the health care system, patient, and family who often live far from treatment centers. Remote home monitoring has successfully reduced unplanned readmissions and intensive care days during readmissions. We aimed to explore the readmissions that are occurring after the neonatal hospital discharge through the end of remote home monitoring through the interstage period using a multi-site cardiac registry.
Methods: Retrospective descriptive analysis of data from the 12 US pediatric cardiac hospitals participating in the Children’s High Acuity Monitoring Program (CHAMP®) Cardiac Research Repository between 2014-2022 (90.5% of patients).CHAMP® is a remote patient monitoring mobile application developed at Children’s Mercy utilized to enable the asynchronous transfer of remote home monitoring data. Demographics and data evaluated included length of stay (LOS), unplanned cardiac procedures, and red flag concern events through the interstage.
Results: Across n=999 subjects, most infants were term, white (79.9%), non-Hispanic (84.0%), male (62.2%), and non-syndromic (79.3%) with CHD being their only congenital anomaly (80.4% with no other major anomaly). Mothers of infants primarily spoke English (92.5%), with 48% being 26 years of age or less, and treating pediatric cardiac hospitals. Of the CHAMP®-monitored infants, 1,944 total interstage readmissions were recorded with a mean of 3 per infant across all sites. Median (IQR) time from neonatal discharge to first readmission was 62.0 (27.0-102.0) days. Median (IQR) LOS during readmissions was 3.0 (1.0-9.0) days with 43.4% of readmissions having ICU days at a median LOS 2.0 (1.0-8.0) days. In total, 576 (29.63%) included unplanned cardiac reinterventions.
Conclusion: The CHAMP cardiac multi-site registry provides insights into a relatively rare CHD at a single-site level but is robust with a multi-site repository. A well-represented infant cohort had an average of three interstage readmissions per infant occurred across all 12 hospitals. First readmissions occurred about 2 months from the neonatal discharge, LOS around a week with numerous ICU days and 30% requiring an unplanned cardiac reintervention. This understanding of interstage readmissions is key to beginning an in-depth analysis of readmission patterns by reason for admission and remote monitoring concerns prompting readmission.
Thompson, Ryan; Ricketts, Amy; Noel-Macdonnell, Janelle R. PhD; Feldman, Keith; and Erickson, Lori A., "Exploring Pediatric Cardiac Readmissions in the Interstage Period Using the CHAMP Multi-Site Repository" (2023). Research at Children's Mercy Month 2023. 11.