Hospital readmissions in Internal Medicine Specialty: Frequency, associated factors and outcomes

Abstract

Objectives: Hospital readmission has become a focus of national attention as a potential indicator of healthcare quality and has a significant financial impact on healthcare system. Limited data is available regarding readmissions to Internal Medicine specialty from our sub-continent. It is, therefore, essential to determine the frequency and factors leading to readmissions, in order to avoid preventable readmissions and improve quality of healthcare provision.
 Methods: This retrospective study reviewed adult discharges from Internal Medicine specialty between October 2018 and February 2019 at Aga Khan University Hospital. Out of 1,835 discharges, 491 were randomly selected after excluding expiries. The frequency, factors and outcomes of readmission were noted. The studied outcomes included length of stay and in-hospital mortality.
 Results: Out of 491 patients, 15.3% were readmitted within 30-days of their discharge. Most of the readmitted patients were females (56%) and elderly with a mean age 67.1±14.9 years. Majority of the patient who got readmitted had multi-morbidities (68%) and were of functional Class-II (39%).The mean length of stay for index and readmission was between 4-7days. Eighty-percent readmissions were discharged as planned, 13% on request and seven-percent left against medical advice in their index admission. The most common causes of readmission were persistence of symptoms (43%) and nosocomial infection (29%). Avoidable causes included hospital-associated pneumonia, urinary tract infections and septic shock. Mortality in readmitted patients was 12%.
 Conclusions: The causes of readmission is multi-factorial, including advanced age, multi-morbidities, persistence of symptoms and nosocomial infections. Early follow-ups should be advised to prevent avoidable readmissions.
 doi: https://doi.org/10.12669/pjms.37.7.3575
 How to cite this:Fatima S, Shamim S, Raffat S, Tariq M. Hospital readmissions in Internal Medicine Specialty: Frequency, associated factors and outcomes. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.3575
 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Nosocomial infections: a look at the problem in the context of the global threat of antibiotic resistance (review)

“…В таком случае пациент обращается в другую МО, которая также испытывает значительные трудности в выборе эмпирической АБТ и несет значительные экономические расходы [55]. Так, в исследовании, проведенном в крупной больнице Пакистана, наиболее частыми причинами повторной госпитализации пациентов в течение 30 дней после выписки были персистенция симптомов (43%) и ВБИ (29%) [56]. Сообщается, что в 76% случаях ИОХВ, связанные с ортопедической операцией, манифестируют после выписки из стационара [57].…”

Readmission rates and predictors of avoidable readmissions in older adults in a tertiary care centre

“…[ 4 ] Factors associated with readmission include improper discharge planning; failure to send the discharge plan to the primary care physician; poor follow-up practices, especially with primary care physicians; lack of social and community support; unclear instructions to patients on discharge; incomplete diagnosis; inadequately treated medical conditions; sub-optimal patient care; errors in medication reconciliation; drug interactions and side effects; frailty; malnutrition; severe chronic conditions; the persistence of underlying chronic conditions; lapses in communication between treating team members and the patient; poor management of self-care activities at home following discharge; inability in accessing health care and keeping appointments; incomplete patient education resulting in lack of awareness of whom to contact; where to go and how to manage symptoms at home; nosocomial infections; and poor adherence to medications due to cost or inaccessibility. [ 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 ] Contributory intrinsic factors include old age, high comorbidity burden, low literacy rate, low socio-economic status, and lack of social networks. [ 9 10 22 23 24 ] Patients discharged against medical advice are at a higher risk for early readmissions, usually within the first day following discharge (bounce-back readmissions).…”

“…[ 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 ] Contributory intrinsic factors include old age, high comorbidity burden, low literacy rate, low socio-economic status, and lack of social networks. [ 9 10 22 23 24 ] Patients discharged against medical advice are at a higher risk for early readmissions, usually within the first day following discharge (bounce-back readmissions). [ 25 ] Most research done on 30-day readmissions focus on the community model-a flow of patients between the community and the hospital.…”