Evaluating readmission rates: how can we improve?

OBJECTIVES

To detect the readmission rates of a hospitalist group at a community hospital, to identify probable causes of rehospitalizations, and to propose solutions to decrease the rate of readmissions.

METHODS

We conducted a retrospective medical chart review on patients who were rehospitalized with the same diagnosis within 30 days over a period of one year.

RESULTS

Among 5,206 patients who were admitted to the hospitalist service over one year, 85 (1.6%) were rehospitalized within 30 days due to the same condition. Of the 85 readmitted patients, 47% were male and 82% were Caucasian, with a mean age of 58 ± 17 years. The top diagnoses were pneumonia, sepsis, and chronic obstructive pulmonary disease (COPD). Follow-up appointments were made for only 27% of patients at first admission. Ninety percent of patients received an accurate medication list at discharge. Mortality within three months was higher in patients with sepsis, more comorbidities, longer length of stay at first hospitalization, and those discharged to a nursing home after readmission. Only 4.7% of readmissions were concluded to be preventable.

CONCLUSION

Our readmission rate (1.6%) is significantly lower than that of previous studies (23.2%), as we included the readmissions only due to the same diagnosis. Patient education, family involvement in discharge process, and scheduling follow-up appointments could potentially reduce readmissions, despite multiple unmodifiable factors. We suspect all-cause readmissions have room for more improvement, which should be the focus of intervention.