Hospital Readmissions within 30 Days after Discharge: A Review of All Readmissions to Hospitalists in One Year

Background:

Readmission to hospital soon after discharge is a significant burden to patients and our health care system. Centers for Medicaid and Medicare services are proposing to add hospital readmissions as a quality measure by 2010. We aimed to study the characteristics of all readmissions within 30 days of discharge from our hospitalist service in 1 year,

Methods:

This was a retrospective chart review of all readmissions to our hospital within 30 days after discharge from the hospitalist service during the year 2007. Patients readmitted to our service were identified from the University Health Consortium database. The review was done by 7 physicians. We defined the factors for readmission as: patient factor (for example, noncompliance with treatment), physician factor (for example, inadequate treatment), disease factor (for example, end‐stage COPD disease), and system issue (for example, lack of primary care physician).

Results:

The total number of readmissions in year 2007 was 239. Fifty‐five percent of all readmissions were men, 54.4% were white, 43.9% were African American, and 1.7% were Hispanic. Seventy‐one percent of readmissions were for the same diagnosis as the original admission, and 37.1% of readmissions were thought to be preventable by the reviewing physicians. Fourteen percent of readmitted patients were discharged to a skilled nursing facility, whereas most patients were discharged home (59.8%) or home with home health services (13%). A new medication was introduced in 15.9% of patients before discharge. The most common reasons for readmission were acute exacerbation of chronic illness (32.3%), medical noncompiiance (19.5%), new diagnosis or problem (18.2%), end‐stage illness (8.2%), failure of outpatient regimen (7.7%), substance abuse (6.4%), medication overdose or side effect (3.6%), and patient leaving against medical advice (2.7%). Patient factor caused 18.8% of readmissions, physician factor caused 2.9% of readmissions, disease factor caused 36.4% of readmissions, and a combination of more than 1 factor caused 33.8% of readmissions.

Conclusions:

In our study, more than one third of our readmissions were thought to be preventable; however, a combination of factors contribute to most readmissions. Interventions targeting multiple levels in the discharge process are necessary to reduce this readmission burden to our patients and health care system.

Author Disclosure:

V. Jeevanantham, none; G. Jao, none; R. Vadlamudi, none; B. Gadi, none; M. Eapen, none; S. Stefanescu, none; P. Agborbesong, none.