Background: There are limited data on factors associated with 30-day readmissions and the frequency of avoidable readmissions among patients with stroke and other cerebrovascular disease. Methods: University HealthSystem Consortium (UHC) database records were used to identify patients discharged with a diagnosis of stroke or other cerebrovascular disease at a university hospital from January 1, 2007 to December 31, 2009 and readmitted within 30 days to the index hospital. Logistic regression models were used to identify patient and clinical characteristics associated with 30-day readmission. Two neurologists performed chart reviews on readmissions to identify avoidable cases. Results: Of 2706 patients discharged during the study period, 174 patients had 178 readmissions (6.4%) within 30 days. The only factor associated with 30-day readmission was the index length of stay >10 days (vs <5 days; odds ratio [OR] 2.3, 95% CI [1.4, 3.7]). Of 174 patients readmitted within 30 days (median time to readmission 10 days), 92 (53%) were considered avoidable readmissions including 38 (41%) readmitted for elective procedures within 30 days of discharge, 27 (29%) readmitted after inadequate outpatient care coordination, 15 (16%) readmitted after incomplete initial evaluations, 8 (9%) readmitted due to delayed palliative care consultation, and 4 (4%) readmitted after being discharged with inadequate discharge instructions. Only 5% of the readmitted patients had outpatient follow-up recommended within 1 week. Conclusions: More than half of the 30-day readmissions were considered avoidable. Coordinated timing of elective procedures and earlier outpatient follow-up may prevent the majority of avoidable readmissions among patients with stroke and other cerebrovascular disease.

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Background: Transcranial Doppler (TCD) monitoring is commonly used to identify cerebral vasospasm in patients with subarachnoid hemorrhage (SAH) though its utility after day 10 has been questioned. The objective of our study was to determine the frequency of vasospasm by TCD in SAH patients who underwent prolonged monitoring (beyond day 10). Methods: We retrospectively identified all SAH patients seen at Emory University Hospital in 2011 who underwent TCD monitoring beyond 10 days. Outcomes of interest included cerebral vasospasm on TCD and delayed ischemic neurological deficit (DIND) beyond day 10. Results: Of 93 patients who met inclusion criteria, 66 (71%) experienced vasospasm and 28 (31%) developed DIND beyond day 10; of patients with DIND, TCD identified vasospasm in 24 (86%). Vasospasm on TCD was a predictor of DIND in univariate analysis (OR 3.29; 95% CI 1.015 to 10.63) but was not significant in multivariable analysis when adjusted for admission Hunt and Hess score. Conclusion: Prolonged TCD monitoring (beyond day 10) identified a high frequency of cerebral vasospasm in our subset of patients though was not a significant predictor of DIND in multivariable analysis. Prolonged TCD monitoring needs to be evaluated in a prospective study to determine its utility as a predictor of DIND.