Return Visits to the Hospital: Causes Among Children

Dr. Yoav Farberov was seeing the same children far too often in Assuta Ashdod’s pediatric ward.

Like the child who had been discharged just a week earlier after suffering a seizure; or the teen who was readmitted for wheezing just a month after he left the hospital.

Why, he wondered, do some children return to the hospital more often than others?

Along with his Assuta Ashdod colleagues Dr. Alon Farfel and Dr. Dorit Mishel-Parnes, Dr. Farberov, a resident physician in the pediatric division, was determined to find an answer.

Over two years, from 2020 to 2021, the doctors followed 99 children who had visited the hospital for non-critical illnesses. They had a hunch that the children who returned for further treatment were not following the medical recommendations they had received upon discharge. Those recommendations could include completing the course of a prescription, undergoing further testing via MRI or X-ray, or scheduling a follow-up visit.

In fact, they found that a full 56 percent of the children who returned to the hospital had not followed doctor-ordered recommendations.

“The treatment given to a child during hospitalization is only a short part of the treatment plan,” said Dr. Farberov in an interview. “In order to be treated well, the child must adhere to the follow up instructions. Most physicians don’t realize that a large number of their patients don’t follow instructions correctly.”

To further direct the study, the doctors also controlled for factors including: the age of the parents, the age of child, the type of illness, the length of hospitalization, and the medical professional administering the discharge.

They were surprised to find that the age of the parents was the one factor that made a significant difference in return hospital visits. It seems that younger parents take doctor-prescribed discharge recommendations less seriously than do older parents. From that finding, the doctors made two major recommendations for Assuta medical staff to follow during the discharge process.

1. When dealing with younger parents, it’s more important to explain the doctor's recommendations in detail.

2. Emphasize the importance of follow up tests, prescriptions, and any other lab work.

(The doctors found that most parents were careful to fill prescriptions for antibiotics, but other medicines less so.)

Younger Parents May Have Less Influence

Dr. Farberov and his colleagues believe that parents don’t fully appreciate the consequences of out-patient medical follow-up.

“Parents should treat their child’s recommendations as if they received them personally,” he said. “One reason that might explain why younger parents are less attentive to follow-up is that they have greater trouble convincing their child to take medication. Older parents, on the other hand, seem to be able to motivate their children better.”

The doctors also compared their results to studies in other countries to discover if Israel was an outlier. They found that, in fact, the results of their study were closely aligned to research performed in Europe and the United States.

Dr. Farberov and his colleagues have submitted their study to a medical journal, where it is awaiting review and possible publication.