Finn Arkadiy, Naqvi Raza, Selvaraj Vijairam, Dapaah-Afriyie Kwame
Division of Hospital Medicine, Department of Medicine Warren Alpert Medical School at Brown University.
Brown J Hosp Med. 2022 Jun 3;1(2):36124. doi: 10.56305/001c.36124. eCollection 2022.
Rapid readmissions, occurring within 7 days of hospital discharge, are associated with significant morbidity and mortality. Objectives: Identify causes of rapid readmissions with a focus on clinical judgement errors and improve discharge practices.
Records of 371 patients discharged from an inpatient medical service and readmitted within 7 days were reviewed. Causes for readmission were identified and classified into 10 categories, including diagnostic and/or therapeutic error leading to readmission.
Fifty percent of rapid readmissions were related to severity of underlying disease/failure to respond to treatment. Adherence challenges, patients with known high hospital utilization, and substance use disorder/uncontrolled psychiatric conditions accounted for 32.4% of 7-day readmissions. Readmissions related to clinical judgement accounted for 24 (6.5%) of the total readmissions. Clinical judgement errors were comprised of 6 diagnostic and 18 therapeutic errors, involving infections, diabetic medications and anticoagulation agents.
Most rapid readmissions are related to the severity of the condition during the index hospitalization. Clinical judgement errors are a rare cause for rapid readmission and involve certain high-risk medications and symptoms which require a high degree of awareness from the discharging provider.
快速再入院是指在出院后7天内发生的再入院情况，与显著的发病率和死亡率相关。目的：确定快速再入院的原因，重点关注临床判断错误，并改进出院流程。
回顾了371名从住院医疗服务中出院并在7天内再次入院的患者的记录。确定了再入院的原因，并将其分为10类，包括导致再入院的诊断和/或治疗错误。
50%的快速再入院与基础疾病的严重程度/对治疗无反应有关。依从性挑战、已知高住院利用率的患者以及物质使用障碍/未控制的精神疾病占7天再入院的32.4%。与临床判断相关的再入院占总再入院的24例（6.5%）。临床判断错误包括6例诊断错误和18例治疗错误，涉及感染、糖尿病药物和抗凝剂。
大多数快速再入院与首次住院期间病情的严重程度有关。临床判断错误是快速再入院的罕见原因，涉及某些高风险药物和症状，出院医生需要高度警惕。
