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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...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2018
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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. |
format | Online Article Text |
id | pubmed-6137861 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
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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