Any Questions? The Relationship Between Responses to Postdischarge Call Questions and 30‐Day Hospital Readmission

Background:

Hospital readmissions have become a focus of national attention as a potential indicator of poor quality and health care waste. Predicting hospital readmission risk would be helpful in identifying patients who would benefit from more intensive care transition interventions; however, several studies have found that most readmission risk prediction models perform poorly. We sought to examine whether responses to specific questions associated with the quality of care transitions were associated with 30‐day readmissions.

Methods:

From June of 2010 to May 2012, 4 nurses at a 600‐bed academic medical center aimed to call all patients returning home within 72 hours of discharge from the inpatient medicine service. For patients with a primary language other than English a phone interpreter was used for the call. Making at least 2 call attempts per patient, nurses followed a standard script to address evidence‐based issues believed to cause hospital readmission with the patient or the caregiver: discharge instructions, medication instructions, ability to obtain prescriptions, arrival of durable medical equipment (if ordered), and contact by home health care providers (if ordered). Responses to call questions and resulting interventions were documented in the electronic medical record and were exported to a database for analysis. Administrative data were used to capture all inpatient discharges and readmissions to the medicine service during this period. Multiple readmissions within 30 days and readmissions within 72 hours were excluded. Responses to each issue item were compared based on readmission status using chi‐square tests.

Results:

Of the 4115 patients receiving a phone call, 2680 (65.1%) completed the call survey. After exclusions, the overall readmission rate for those receiving a call was 5.8%. There were no significant differences between readmitted and nonreadmitted patients in positive responses to items (Table 1) . Readmitted patients were not more likely to have questions or issues addressed on postdischarge phone calls. This was true for individual issues as well as for any issue addressed by the call.

Conclusions:

Patient responses to items relating to the quality of care transitions were not found to be associated with an increased risk for readmission. This finding could be a result of the success of nurses in intervening on postdischarge issues or the inability of follow‐up phone calls to identify patients at risk for readmissions. This study suggests that there are likely to be other causes for patient readmission that are not often addressed in standard postdischarge phone calls to patients.