Raiss Monica E, Mehta Krisha K, Zhang Xiaoyue, Kabacinski Andrea, Martorana Denise, Mischo Julia, Stopeck Alison, La Torre Grace N
Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA.
Stony Brook University Hospital, Stony Brook, NY, USA.
Support Care Cancer. 2025 Feb 19;33(3):206. doi: 10.1007/s00520-025-09215-0.
Unplanned readmissions have profound medical and financial implications for patients and hospitals. Cancer patients are particularly susceptible to readmission and often face complex care needs. This quality improvement project aimed to identify factors associated with avoidable hospitalizations among oncology patients.
Hospital discharges of adult cancer patients at Stony Brook University Hospital (June 2021-July 2022) were reviewed to identify unplanned 30-day readmissions. Readmissions were categorized as avoidable or unavoidable. Factors analyzed included patient demographics, cancer characteristics, social factors, outpatient follow-up, and palliative care involvement.
Of the 468 hospitalized cancer patients, 96 (21%) were readmitted within 30 days of discharge. Most readmitted patients had stage IV disease (51%). Fifty-seven percent of patients were symptomatic on index admission compared to 100% on readmission. Pain was the most frequently reported symptom, increasing from 36 patients (38%) on index admission to 54 (56%) on readmission (p < 0.001). Notably, 16 patients (17%) were discharged on comfort-focused care and 11 (12%) died inpatient on readmission. Palliative care was consulted 2.3 times more frequently during readmission compared to index admission. Readmissions were determined to be avoidable for 27 patients (28%). A complaint of failure to thrive on readmission (p < 0.04), no identifiable post-discharge caretaker (p < 0.009), being symptomatic at index admission (p < 0.04), and not attending an outpatient visit prior to readmission (p < 0.05) were associated with avoidable readmissions.
Timely outpatient support and early palliative care involvement to manage symptoms and optimize care transitions are readily addressable measures that may reduce avoidable readmissions among advanced-stage cancer patients.
非计划再入院对患者和医院有着深远的医学和经济影响。癌症患者尤其容易再入院，且常常面临复杂的护理需求。本质量改进项目旨在确定肿瘤患者中与可避免住院相关的因素。
回顾了石溪大学医院（2021年6月至2022年7月）成年癌症患者的出院情况，以确定30天内的非计划再入院情况。再入院被分为可避免或不可避免两类。分析的因素包括患者人口统计学特征、癌症特征（癌症特性）、社会因素、门诊随访情况以及姑息治疗参与情况。
在468名住院癌症患者中，96名（21%）在出院后30天内再次入院。大多数再入院患者患有IV期疾病（51%）。初次入院时有症状的患者占57%，而再入院时这一比例为100%。疼痛是最常报告的症状，从初次入院时的36名患者（38%）增加到再入院时的54名（56%）（p < 0.001）。值得注意的是，16名患者（17%）出院时接受以舒适为重点的护理，11名（12%）在再入院时住院期间死亡。与初次入院相比，再入院期间咨询姑息治疗的频率高出2.3倍。确定27名患者（28%）的再入院是可避免的。再入院时出现衰弱主诉（p < 0.04）、出院后没有可确定的护理人员（p < 0.009）、初次入院时有症状（p < 0.04）以及再入院前未参加门诊就诊（p < 0.05）与可避免再入院相关。
及时的门诊支持和早期姑息治疗参与以管理症状并优化护理过渡是易于实施的措施，可能会减少晚期癌症患者中可避免的再入院情况。
