Factors associated with unplanned readmissions within 1 day of acute care discharge: a retrospective cohort study

Abstract

BackgroundUnplanned hospital readmissions are a quality and safety indicator. In Australian, 8% to 11.1% of unplanned readmissions occur ≤1 day of acute care discharge. The aim of this study was to explore the reasons for unplanned hospital readmissions ≤1 day of acute care discharge, and determine what proportion of such unplanned hospital readmissions were potentially preventable.MethodsA retrospective exploratory cohort design was used to conduct this two phase study. In Phase 1, organisational data from 170 readmissions ≤1 day and 1358 readmissions between 2 and 28 days were compared using the Cochran-Mantel-Haenszel test. Binary logistic regression was used to examine factors associated with unplanned readmission ≤1 day. In Phase 2, a medical record audit of 162 Phase 1 readmissions ≤1 day was conducted and descriptive statistics used to summarise the study data. Index discharges occurred between 1 August and 31 December 2015.ResultsIn Phase 1, unplanned readmissions ≤1 day were more likely in paediatric patients (< 0.001); index discharges on weekends (p = 0.006), from short stay unit (SSU) (p < 0.001) or against health professional advice (p = 0.010); or when the readmission was for a Diagnosis Related Group (p < 0.001). The significant predictors of unplanned readmission ≤1 day were index discharge against advice or from SSU, and 1–5 hospital admissions in the 6 months preceding index admission.In Phase 2, 88.3% readmissions were unpreventable and 11.7% were preventable. The median patient age was 57 years and comorbidities were uncommon (3.1%). Most patients (94.4%) lived at home and with others (78.9%). Friday was the most common day of index discharge (17.3%) and Saturday was the most common day of unplanned readmission (19.1%). The majority (94.4%) of readmissions were via the emergency department: 58.5% were for a like diagnosis and pain was the most common reason for readmission.ConclusionsAdvanced age, significant comorbidities and social isolation did not feature in patients with an unplanned readmission ≤1 day. One quarter of patients were discharged on a Friday or weekend, one quarter of readmissions occurred on a weekend, and pain was the most common reason for readmission raising issues about access to services and weekend discharge planning.

Understanding the patient experience of early unplanned hospital readmission following acute care discharge: a qualitative descriptive study

“…9 Index discharge from a short stay unit was associated with the highest proportion of preventable unplanned readmissions within 1 day. 9 The published literature to date has focused on identifying patient characteristics and other risk factors for unplanned hospital readmissions. 4 10-15 The patient experience of unplanned hospital readmission is poorly understood and qualitative studies to date have focused on clinician perspectives 16 17 or specific patient groups such as older patients, 18 patients with heart failure 19 or survivors of critical illness.…”

“…The interviews were conducted at the patients' bedside using an interview guide (online supplementary appendix 1), were audiorecorded, and were a maximum of 21 min duration (average=10.6 min). The interview guide was informed by the literature [30][31][32] and previous work related to unplanned hospital readmissions within 1 day of acute care discharge that highlighted that discharge planning is poorly understood, 9 and particularly the patient perspective of discharge planning. Interview numbers were deemed sufficient when data saturation had been reached.…”

“…5 7 One in eight unplanned readmissions within 1 day were deemed preventable and one quarter of patients experiencing unplanned readmission within 1 day were discharged on a Friday or weekend. 9 Pain was the most common reason for readmission within 1 day. 9 Index discharge from a short stay unit was associated with the highest proportion of preventable unplanned readmissions within 1 day.…”

“…9 Pain was the most common reason for readmission within 1 day. 9 Index discharge from a short stay unit was associated with the highest proportion of preventable unplanned readmissions within 1 day. 9 The published literature to date has focused on identifying patient characteristics and other risk factors for unplanned hospital readmissions.…”

Cost‐effectiveness of the Collaborative Care to Preserve Performance in Cancer (COPE) trial tele‐rehabilitation interventions for patients with advanced cancers

“…Given the mounting concern over cancer costs, surprisingly, limited attention has been directed to potentially remediable drivers of patients’ requirement for health‐care services, namely pain and disablement. Associations between patients’ pain and their hospital and emergency department usage have been long recognized, particularly among cancer cohorts . However, linkages between patients’ functional status and their health‐care consumption, though robust, have received less attention.…”