Factors associated with unplanned readmissions within 1 day of acute care discharge: a retrospective cohort study
Abstract Background Unplanned hospital readmissions are a quality and safety indicator. In Australian, 8% to 11.1% of unplanned readmissions occur ≤1 day of acute care discharge. The aim of this study was to explore the reasons for unplanned hospital readmissions ≤1 day of acute care discharge, and...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-09-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12913-018-3527-6 |
| _version_ | 1798046147435036672 |
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| author | Julie Considine Debra Berry Evan Newnham Matthew Jiang Karen Fox David Plunkett Melissa Mecner Peteris Darzins Mary O’Reilly |
| author_facet | Julie Considine Debra Berry Evan Newnham Matthew Jiang Karen Fox David Plunkett Melissa Mecner Peteris Darzins Mary O’Reilly |
| author_sort | Julie Considine |
| collection | DOAJ |
| description | Abstract Background Unplanned hospital readmissions are a quality and safety indicator. In Australian, 8% to 11.1% of unplanned readmissions occur ≤1 day of acute care discharge. The aim of this study was to explore the reasons for unplanned hospital readmissions ≤1 day of acute care discharge, and determine what proportion of such unplanned hospital readmissions were potentially preventable. Methods A retrospective exploratory cohort design was used to conduct this two phase study. In Phase 1, organisational data from 170 readmissions ≤1 day and 1358 readmissions between 2 and 28 days were compared using the Cochran-Mantel-Haenszel test. Binary logistic regression was used to examine factors associated with unplanned readmission ≤1 day. In Phase 2, a medical record audit of 162 Phase 1 readmissions ≤1 day was conducted and descriptive statistics used to summarise the study data. Index discharges occurred between 1 August and 31 December 2015. Results In Phase 1, unplanned readmissions ≤1 day were more likely in paediatric patients (< 0.001); index discharges on weekends (p = 0.006), from short stay unit (SSU) (p < 0.001) or against health professional advice (p = 0.010); or when the readmission was for a Diagnosis Related Group (p < 0.001). The significant predictors of unplanned readmission ≤1 day were index discharge against advice or from SSU, and 1–5 hospital admissions in the 6 months preceding index admission. In Phase 2, 88.3% readmissions were unpreventable and 11.7% were preventable. The median patient age was 57 years and comorbidities were uncommon (3.1%). Most patients (94.4%) lived at home and with others (78.9%). Friday was the most common day of index discharge (17.3%) and Saturday was the most common day of unplanned readmission (19.1%). The majority (94.4%) of readmissions were via the emergency department: 58.5% were for a like diagnosis and pain was the most common reason for readmission. Conclusions Advanced age, significant comorbidities and social isolation did not feature in patients with an unplanned readmission ≤1 day. One quarter of patients were discharged on a Friday or weekend, one quarter of readmissions occurred on a weekend, and pain was the most common reason for readmission raising issues about access to services and weekend discharge planning. |
| first_indexed | 2024-04-11T23:33:56Z |
| format | Article |
| id | doaj.art-d63842fea2394430a9ee2902bdac5beb |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-04-11T23:33:56Z |
| publishDate | 2018-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-d63842fea2394430a9ee2902bdac5beb2022-12-22T03:57:03ZengBMCBMC Health Services Research1472-69632018-09-0118111110.1186/s12913-018-3527-6Factors associated with unplanned readmissions within 1 day of acute care discharge: a retrospective cohort studyJulie Considine0Debra Berry1Evan Newnham2Matthew Jiang3Karen Fox4David Plunkett5Melissa Mecner6Peteris Darzins7Mary O’Reilly8Geelong: School of Nursing and Midwifery and Centre for Quality and Patient Safety – Eastern Health Partnership, Deakin UniversityGeelong: School of Nursing and Midwifery and Centre for Quality and Patient Safety – Eastern Health Partnership, Deakin UniversityEastern HealthEastern HealthEastern HealthEastern HealthEastern HealthEastern HealthEastern HealthAbstract Background Unplanned hospital readmissions are a quality and safety indicator. In Australian, 8% to 11.1% of unplanned readmissions occur ≤1 day of acute care discharge. The aim of this study was to explore the reasons for unplanned hospital readmissions ≤1 day of acute care discharge, and determine what proportion of such unplanned hospital readmissions were potentially preventable. Methods A retrospective exploratory cohort design was used to conduct this two phase study. In Phase 1, organisational data from 170 readmissions ≤1 day and 1358 readmissions between 2 and 28 days were compared using the Cochran-Mantel-Haenszel test. Binary logistic regression was used to examine factors associated with unplanned readmission ≤1 day. In Phase 2, a medical record audit of 162 Phase 1 readmissions ≤1 day was conducted and descriptive statistics used to summarise the study data. Index discharges occurred between 1 August and 31 December 2015. Results In Phase 1, unplanned readmissions ≤1 day were more likely in paediatric patients (< 0.001); index discharges on weekends (p = 0.006), from short stay unit (SSU) (p < 0.001) or against health professional advice (p = 0.010); or when the readmission was for a Diagnosis Related Group (p < 0.001). The significant predictors of unplanned readmission ≤1 day were index discharge against advice or from SSU, and 1–5 hospital admissions in the 6 months preceding index admission. In Phase 2, 88.3% readmissions were unpreventable and 11.7% were preventable. The median patient age was 57 years and comorbidities were uncommon (3.1%). Most patients (94.4%) lived at home and with others (78.9%). Friday was the most common day of index discharge (17.3%) and Saturday was the most common day of unplanned readmission (19.1%). The majority (94.4%) of readmissions were via the emergency department: 58.5% were for a like diagnosis and pain was the most common reason for readmission. Conclusions Advanced age, significant comorbidities and social isolation did not feature in patients with an unplanned readmission ≤1 day. One quarter of patients were discharged on a Friday or weekend, one quarter of readmissions occurred on a weekend, and pain was the most common reason for readmission raising issues about access to services and weekend discharge planning.http://link.springer.com/article/10.1186/s12913-018-3527-6Patient safetyPatient readmissionHospital readmissionDischarge planningHospitalizationHealth services |
| spellingShingle | Julie Considine Debra Berry Evan Newnham Matthew Jiang Karen Fox David Plunkett Melissa Mecner Peteris Darzins Mary O’Reilly Factors associated with unplanned readmissions within 1 day of acute care discharge: a retrospective cohort study BMC Health Services Research Patient safety Patient readmission Hospital readmission Discharge planning Hospitalization Health services |
| title | Factors associated with unplanned readmissions within 1 day of acute care discharge: a retrospective cohort study |
| title_full | Factors associated with unplanned readmissions within 1 day of acute care discharge: a retrospective cohort study |
| title_fullStr | Factors associated with unplanned readmissions within 1 day of acute care discharge: a retrospective cohort study |
| title_full_unstemmed | Factors associated with unplanned readmissions within 1 day of acute care discharge: a retrospective cohort study |
| title_short | Factors associated with unplanned readmissions within 1 day of acute care discharge: a retrospective cohort study |
| title_sort | factors associated with unplanned readmissions within 1 day of acute care discharge a retrospective cohort study |
| topic | Patient safety Patient readmission Hospital readmission Discharge planning Hospitalization Health services |
| url | http://link.springer.com/article/10.1186/s12913-018-3527-6 |
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