Research paper
Understanding readmissions: An in-depth review of 50 patients readmitted back to an acute hospital within 30 days

https://doi.org/10.1016/j.eurger.2012.02.007Get rights and content

Abstract

Background

Readmissions back into an acute hospital are attracting greater interest as a marker of disconnect between primary, secondary and social care.

Objective

To develop an in-depth understanding of the reasons contributing towards short-term readmissions in older people, and identifying potential interventions.

Design

In-depth analysis of 50 patients readmitted back into an acute hospital within 30 days; thematic analysis.

Setting

A large acute teaching hospital in the East Midlands, UK.

Subjects

People aged 70 years or older readmitted within 30 days from any speciality into the Acute Medical Unit.

Methods

Simple descriptive statistics were used to describe the nature of the sample examined, and thematic analysis was undertaken to summarise the main causes underpinning the readmission.

Results

Fifty patients with a mean age 82.2 years, 46% male, 9% from their own home, 50% with cognitive impairment, mean 5.2 co-morbidities, mean 6.5 medications and median Rockwoood frailty score 5. Sixty-four percent of the readmissions were related to the index admission, the majority medical in nature (69%) of which 86% were potentially preventable.

Conclusions

Most short-term readmissions to an acute hospital are driven by medical issues, which might be addressed by comprehensive assessment during the index admission and early follow-up.

Section snippets

Key points

In older people most short-term readmissions to an acute hospital are driven by medical issues.

Many readmissions are potentially avoidable.

Comprehensive geriatric assessment during the index admission and rapid follow-up may reduce readmission rates.

Background

Older people are major users of acute hospital care; if admitted for inpatient hospital care, older people have the longest lengths of stay, the highest readmission rates and highest rate of long-term care use after discharge [1]. Reducing the number and the duration of acute hospital admissions is a major focus of health policy in England and Wales [2]; with policies in place to increase the funding paid for an acute episode of care, but with the hospital becoming accountable for readmissions

Methods

The study took place at the Leicester Royal Infirmary, East Midlands, UK in 2011; this hospital admits approximately 20,000 patients per annum into medical specialities. The mean 30 days readmission rates for all ages are 13.4%, but for those aged 85 years or more, reach 17.4%.

People aged 70 years or older readmitted within 30 days from any speciality into the Acute Medical Unit (AMU) at the Leicester Royal Infirmary were identified by checking on hospital systems for evidence of a previous

Results

In July 2011, 50 patients (18.5% of all those aged 70+) were identified on the AMU that had been admitted to the hospital within the previous 30 days. The baseline characteristics of the study population are shown in Table 1.

In 32 out of 50 (64%), the readmissions appeared to be related to the index admission, the majority judged to be medical in nature (22/32, 69%) of which 19 out of 22 (86%) were potentially preventable (Fig. 1).

Overall, 39 out of 50 (78%) of readmission had an underlying

Discussion

This study attempted to describe the underlying factors for an older person being readmitted to hospital, as well as describing interventions that may have made a difference. Patients readmitted often came from their own homes; cognitive impairment, co-morbidities and polypharmacy were common. The length of stay for readmitted patients was not dissimilar to the index length of stay, suggesting that readmissions were not simple or easy to resolve.

In 39 out of 50 (70%) patients, a medical

Conclusion

Most short-term readmissions to an acute hospital are driven by medical issues, which might be addressed by comprehensive assessment during the index admission and early follow-up. Hospitals seeking to reduce readmissions should focus on ensuring older people, especially those with cognitive impairment, multiple co-morbidities, polypharmacy and disability, receive comprehensive geriatric assessment during their acute hospital stay.

Disclosure of interest

The authors declare that they have no conflicts of interest concerning this article.

Funding: funding for the work was from Leicester, Leicestershire and Rutland primary care trust; the funder had no role in the design, analysis or interpretation of the findings.

References (22)

  • D.P. Goeman et al.

    Back for more: a qualitative study of emergency department reattendance for asthma

    Med J Aust

    (2004)
    • View full text
    Copyright © 2012 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.