Friday, April 15, 2016

Readmissions - causes and prevention

Preventability and Causes of Readmissions in a National Cohort of General Medicine Patients

These authors point out that readmission penalties have increased interest in improving care transitions. They studied 1000 general medicine patients (median age 55 years) readmitted within 30 days of discharge to 12 US academic medical centers between April 1, 2012, and March 31, 2013.

They found that 269 (26.9%) of the readmissions were potentially preventable.
The factors most strongly associated with potential preventability included
* emergency department (ED) decision making regarding the readmission
* failure to relay important information to outpatient health care professionals
* discharge of patients too soon
* lack of discussions about care goals among patients with serious illnesses
* inability to keep appointments after discharge
* patient lack of awareness of whom to contact after discharge

They concluded that approximately one-quarter of readmissions are potentially preventable when assessed using multiple perspectives. High-priority areas for improvement efforts include improved communication among health care teams and between health care professionals and patients, greater attention to patients’ readiness for discharge, enhanced disease monitoring, and better support for patient self-management.

Comment: While these were 'general medicine' patients, the lessons from this study can surely be applied to the costly problem of orthopaedic  readmissions. The ED may readmit patients that can be otherwise managed, especially if there is a lack of communication with the orthopaedic service. If primary care physicians are not informed about the patient's condition, readmissions may result. Excessive emphasis on shortening the length of stay may result in discharge before the patient and family are prepared. And patients uninformed about expectations, appointments and 'who to call' may cause the patient to return to the medical center.

In that readmissions within 30 days are likely to be unfunded, it is easy to imagine the cost-savings if a quarter of the readmissions could be prevented.


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