Why did you come back to the hospital? A qualitative analysis of 72-hour readmissions

ABSTRACT

Objectives

Readmissions occurring within a few days of discharge are more likely due to a problem from the patient’s original admission and may be preventable by interventions in the hospital setting. As part of a quality improvement project intended to reduce readmissions within 72 hours of discharge our objective was to explore patient and physician perspectives of reasons for readmissions and to identify potential indicators of readmission during the index admission.

Methods

A retrospective chart review of all readmissions within 72 hours between 2/1/2019 and 6/7/2019 in our healthcare system comprised of an academic medical center and 2 smaller community hospitals. As part of a hospital protocol, patients readmitted within 30 days were interviewed by a social worker regarding reasons for readmission and their perspective on what might have prevented it. These answers, physician notes relevant to the reason for readmission and the clinical course of the index admission were abstracted from patient charts. For the subset of patients identified by themselves or their physicians as potentially benefitting from a longer hospitalization, their index admission was reviewed for indicators of readmission. Reasons for readmission, potential preventive measures, and indicators of readmission were independently reviewed by two authors then grouped into common themes by consensus.

Results

One hundred and thirty-one patients readmitted within 72 hours were identified. Most patients were readmitted for infection related, cardiac or pulmonary reasons. Extending the initial admission was the most common factor suggested by both patients and physicians to prevent readmission. Focusing on 70 patients who may have benefited from a longer admission, indicators included patients not returning to their baseline health status, inadequate management of a known issue, or new symptoms developing during the index admission.

Conclusions

Patients should be evaluated for indicators of readmission, which may help guide decisions to discharge patients and decrease rates of 72-hour readmissions.

KEYWORDS:

• Hospital readmissions
• discharge planning
• patient discharge
• patient readmission