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Factors associated with unplanned readmissions within 1 day of acute care discharge: a retrospective cohort study

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 determin...

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Autores principales: Considine, Julie, Berry, Debra, Newnham, Evan, Jiang, Matthew, Fox, Karen, Plunkett, David, Mecner, Melissa, Darzins, Peteris, O’Reilly, Mary
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6137861/
https://www.ncbi.nlm.nih.gov/pubmed/30217155
http://dx.doi.org/10.1186/s12913-018-3527-6
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author Considine, Julie
Berry, Debra
Newnham, Evan
Jiang, Matthew
Fox, Karen
Plunkett, David
Mecner, Melissa
Darzins, Peteris
O’Reilly, Mary
author_facet Considine, Julie
Berry, Debra
Newnham, Evan
Jiang, Matthew
Fox, Karen
Plunkett, David
Mecner, Melissa
Darzins, Peteris
O’Reilly, Mary
author_sort Considine, Julie
collection PubMed
description 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.
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spelling pubmed-61378612018-09-15 Factors associated with unplanned readmissions within 1 day of acute care discharge: a retrospective cohort study Considine, Julie Berry, Debra Newnham, Evan Jiang, Matthew Fox, Karen Plunkett, David Mecner, Melissa Darzins, Peteris O’Reilly, Mary BMC Health Serv Res Research Article 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. BioMed Central 2018-09-14 /pmc/articles/PMC6137861/ /pubmed/30217155 http://dx.doi.org/10.1186/s12913-018-3527-6 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Considine, Julie
Berry, Debra
Newnham, Evan
Jiang, Matthew
Fox, Karen
Plunkett, David
Mecner, Melissa
Darzins, Peteris
O’Reilly, Mary
Factors associated with unplanned readmissions within 1 day of acute care discharge: a retrospective cohort study
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 Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6137861/
https://www.ncbi.nlm.nih.gov/pubmed/30217155
http://dx.doi.org/10.1186/s12913-018-3527-6
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