Review of 7‐Day Readmissions to a Hospital Medicine Program in an Academic Medical Center

Background:

Since the advent of hospitalist programs, multiple studies reported in the literature have compared readmission rates on hospitalist and nonhospitalist services. However, specific reasons for readmission are often not available.

Purpose:

To describe the experience of a recently established hospital medicine program at a large academic medical center with regard to 7‐day readmissions and their causes.

Description:

The medical center comprises 2 hospital facilities with a total of 400 inpatient beds. A hospital medicine program was established in 2003 to assume responsibility for the teaching medicine services at these hospitals.

Seven‐day readmissions to the service between November 2004 and September 2005 were reviewed retrospectively. The cases were evaluated by 2 members of the Division of Hospital Medicine to determine what factors contributed to the readmission; patient, physician, and system factors were considered. Multiple factors could be considered contributory to any readmission case.

Conclusions:

One hundred and six cases were reviewed from the specified period (out of approximately 4500 admissions total to the service). Patient factors were the most common reason for readmission, with 47% and 41% of the cases related to a new medical problem or exacerbation of a chronic illness, respectively; 18% of cases were due in part to patients not responding to appropriate therapy, 17% of cases were related to patient noncompliance with therapy, and 3% of cases were related to patient noncompliance with follow‐up appointments.

With regard to physician factors, 10% of cases were related to an incorrect or incomplete diagnosis, with 6% of cases due in part to incorrect therapy and 3% of cases related to a complication of therapy.

System factors were surprisingly uncommon, with 5% of cases due in part to an inability to provide therapy in the outpatient setting and 3% of cases due to a lack of available follow‐up care.

Although patient factors seem to account for the substantial majority of 7‐day readmissions to our hospital medicine service, there were enough readmissions related to physician factors to merit further review of future cases in order to determine opportunities for improvement.

Author Disclosure:

B. J. Clay, None; L. Martin, None