National trends in emergency readmission rates: a longitudinal analysis of administrative data for England between 2006 and 2016

Abstract

ObjectiveTo assess trends in 30-day emergency readmission rates across England over one decade.DesignRetrospective study design.Setting150 non-specialist hospital trusts in England.Participants23 069 134 patients above 18 years of age who were readmitted following an initial admission (n=62 584 297) between April 2006 and February 2016.Primary and secondary outcomesWe examined emergency admissions that occurred within 30 days of discharge from hospital (‘emergency readmissions’) as a measure of healthcare quality. Presented are overall readmission rates, and disaggregated by the nature of the indexed admission, including whether it was elective or emergency, and by clinical health condition recorded. All rates were risk-adjusted for patient age, gender, ethnicity, socioeconomic status, comorbidities and length of stay.ResultsThe average risk-adjusted, 30-day readmission rate increased from 6.56% in 2006/2007 to 6.76% (P<0.01) in 2012/2013, followed by a small decrease to 6.64% (P<0.01) in 2015/2016. Emergency readmissions for patients discharged following elective procedures decreased by 0.13% (P<0.05), whereas those following emergency admission increased by 1.27% (P<0.001). Readmission rates for hip or knee replacements decreased (−1.29%; P<0.001); for acute myocardial infarction (−0.04%; P<0.49), stroke (+0.62%; P<0.05), chronic obstructive pulmonary disease (+0.41%; P<0.05) and heart failure (+0.15%; P<0.05) remained stable; and for pneumonia (+2.72%; P<0.001), diabetes (+7.09%; P<0.001), cholecystectomy (+1.86%; P<0.001) and hysterectomy (+2.54%; P<0.001) increased.ConclusionsOverall, emergency readmission rates in England remained relatively stable across the observation period, with trends of slight increases contained post 2012/2013. However, there were large variations in trends across clinical areas, with some experiencing marked increases in readmission rates. This highlights the need to better understand variations in outcomes across clinical subgroups to allow for targeted interventions that will ensure highest standards of care provided for all patients.

Quality Improvement: Supporting a hospital in difficulty: ­experience of a ‘­buddying’ agreement to implement a new medical pathway

“…4,5 However, compared to the ∼13% readmission rate for emergency (unplanned) admissions reported from 150 non-specialist hospitals in England in 2015-6, the MFT rate of ∼15% indicates that further work is needed to address this. 14 This study supports previous data reporting that optimising patient flow improves QoC, reduces cost and uses available capacity better. 4-6 , 15-21 The EAP demand is surprisingly predictable with two-thirds of attendances arriving during normal working hours.…”

“…4-6 , 15-21 The EAP demand is surprisingly predictable with two-thirds of attendances arriving during normal working hours. 14,15,17 Unfortunately, many patients are not seen by senior decision makers before they leave in the evening due to daytime processing delays. This can lead to inappropriate admissions and inefficient use of resource.…”

Interventions to Improve Discharge from Acute Adult Mental Health Inpatient Care to the Community: Systematic Review and Narrative Synthesis

“…This was further informed by the selection of the outcomes or measures used; which seemed in some cases to be pragmatic proxies rather than based upon a specific theory of change. For example, there is an emerging body of literature questioning the effectiveness of readmission as an outcome in mental health, as it only describes service use not clinical need [75,76]. Research suggests that using a framework to guide improvement initiatives is beneficial, for example using the action-effect method (a systematic, structured approach to identify and articulate an improvement interventions theoretical assumption) [77].…”

Interventions to Improve Discharge from Acute Adult Mental Health Inpatient Care to the Community: Systematic Review and Narrative Synthesis

“…This could also be exacerbated by the fact that the outcomes are arguably not indicative of the success of an intervention as they can be easily confounded by external variables. A recent report by The Kings Fund has questioned the validity of using clinical outcomes for a mental health population and recognised the importance of social and emotional outcomes [75].…”

“…In some cases, these were pragmatic proxies rather than based upon a specific theory of change. For example, there is an emerging body of literature questioning the effectiveness of readmission as an outcome in mental health, as it only describes service use not clinical need [75,76]. Research suggests that using a framework to guide improvement initiatives is beneficial, for example using the action-effect method (a systematic, structured approach to identify and articulate an improvement interventions theoretical assumption) [77].…”