Digital Health Unit, Department of Primary Care and Public Health, Imperial College, London, United Kingdom.
School of Public Health, Imperial College London, Chelsea and Westminster Campus, London, United Kingdom.
PLoS One. 2019 Jun 13;14(6):e0218128. doi: 10.1371/journal.pone.0218128. eCollection 2019.
Readmissions are a recognised challenge for providers of healthcare and incur financial penalties in a growing number of countries. However, the scale of unscheduled hospital contacts including attendances at emergency departments that do not result in admission is not well known. In addition, little is known about the route to readmission for patients recently discharged from an emergency hospital stay.
This is an observational study of national hospital administration data for England. In this retrospective cohort study, we tracked patients for 30 days after discharge from an emergency admission for heart failure (HF) or chronic obstructive pulmonary disorder (COPD).
The majority of patients (COPD:79%; HF:75%) had no unscheduled contact with secondary health care within 30 days of discharge. Of those who did have unscheduled contact, the most common first unscheduled contact was emergency department (ED) attendance (COPD:16%; HF:18%). A further 5% of COPD patients and 4% of HF patients were admitted for an emergency inpatient stay, but not through the ED. A small percentage of patients (COPD:<1%, HF:2%) died without any known contact with secondary care. ED conversion rates at first attendance for both COPD and HF were high: 75% and 79% respectively. A quarter of patients who were not admitted during this first ED attendance attended the ED again within the 30-day follow-up period, and around half (COPD:56%; HF:63%) of these were admitted at this point. Patients who live alone, had an index admission which included an overnight stay and were comorbid had higher odds of being admitted through the ED than via other routes.
While the majority of patients did not have unscheduled contact with secondary care in the 30 days after index discharge, many patients attended the ED, often multiple times, and many were admitted to hospital, not always via the ED. More frail patients were more likely to be admitted through the ED, suggesting a possible area of focus as discharge bundles are developed.
再入院是医疗服务提供者面临的一个公认挑战，在越来越多的国家都会因此受到经济处罚。然而，包括急诊就诊但未住院的非计划性住院接触的规模尚不清楚。此外，对于最近从急诊住院出院的患者再次入院的途径知之甚少。
这是一项针对英格兰国家医院管理数据的观察性研究。在这项回顾性队列研究中，我们对因心力衰竭（HF）或慢性阻塞性肺疾病（COPD）急诊入院的患者在出院后 30 天内进行了跟踪。
大多数患者（COPD：79%；HF：75%）在出院后 30 天内没有与二级医疗保健机构进行非计划性接触。在那些有非计划性接触的患者中，最常见的首次非计划性接触是急诊就诊（COPD：16%；HF：18%）。另有 5%的 COPD 患者和 4%的 HF 患者因紧急住院而再次入院，但并非通过急诊。少数患者（COPD：<1%，HF：2%）在没有任何二级医疗接触的情况下死亡。首次就诊时 COPD 和 HF 的 ED 转化率都很高：分别为 75%和 79%。在这 30 天的随访期间，有四分之一的未入院患者再次到 ED 就诊，其中约一半（COPD：56%；HF：63%）在此时住院。独居、有过夜住院史且合并症较多的患者通过 ED 入院的可能性高于其他途径。
虽然大多数患者在出院后 30 天内没有与二级医疗保健机构进行非计划性接触，但许多患者就诊 ED，且经常多次就诊，其中许多人住院，并非总是通过 ED。病情更脆弱的患者更有可能通过 ED 入院，这表明在制定出院套餐时可能需要关注这一问题。
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