Hospital readmission
Hospital readmission refers to the unplanned return of a patient to the hospital within thirty days of discharge, often due to unresolved or worsening medical conditions. This phenomenon is a growing concern in healthcare due to its emotional, physical, and financial implications for patients and their families. Readmissions can lead to additional health risks, such as hospital-acquired infections, and may strain hospital resources, affecting patient care and accessibility. Certain populations, particularly older adults, uninsured individuals, and those with lower incomes, are more susceptible to readmissions. Factors contributing to readmissions often stem from premature discharge, inadequate follow-up care, or patient misunderstandings about post-discharge instructions. Hospitals are actively working to reduce readmission rates through better discharge planning, patient education, and follow-up care coordination. Strategies may include thorough staff training, ensuring patients have proper support at home, and making follow-up appointments. These efforts are critical not only for improving patient outcomes but also for managing healthcare costs effectively.
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Hospital readmission
Hospital readmission occurs when a patient has an unplanned return to the hospital for additional care within thirty days of being discharged. Patients are considered to be readmitted when they return to the hospital within thirty days because the condition for which they were first admitted is not fully resolved, reoccurs, or worsens. Unplanned hospital readmissions are a concern because of the emotional, physical, and financial toll they take on the patient and the patient's family. Readmission also increases the risk of hospital-acquired infections, affects the availability of beds for other patients, and influences health insurance costs.
Background
Hospital readmissions refer to situations in which a person is treated in the hospital two or more times within a month for the same condition or a related condition. Patients who must return to the hospital within thirty days because of an infection related to their original stay (such as an infected surgical incision) or because their initial condition has worsened or reoccurred (such as a heart disease patient admitted for a second heart attack) are considered to be readmitted. The term applies to situations in which it is reasonable to expect that the treatment received during the initial stay would be sufficient, and the patient would not require additional inpatient care in a hospital.
There are many instances in which it is expected that a patient will return to the hospital within a month of being discharged. For example, the patient may need care that requires multiple surgical procedures in a short period and may go home in between. The patient may seek emergency care at one hospital and have a condition that requires surgery or other treatment; in some cases, the patient may be stabilized and sent home, returning a few weeks later for scheduled surgery. These are generally considered separate admissions, not readmissions, because they are planned.
There are other instances where a person might be in the hospital twice within thirty days where it is not considered a readmission. For example, a woman who has a baby and two weeks later sustains injuries in a car accident that require hospital treatment would not be considered a readmission because the two incidents are unrelated.
Overview
Readmissions are a significant concern for hospitals and health insurers. The rate at which people return to the hospital after an initial stay factors into concerns about patient care, hospital efficiency, and health care costs. Since the implementation of the Affordable Care Act (ACA) in 2010, US hospitals have also faced the possibility of penalties if their readmission rates are higher than the established standard, under the Hospital Readmissions Reduction Program (HRRP), whose creation was mandated by the ACA. The HRRP went into effect in 2012; a study published in 2015 found that hospital readmissions had declined in the first several years after the implementation of the HRRP. However, a study published in 2017 suggested that this decline was mainly due to changes in billing practices made in an effort to avoid penalties.
Penalties aside, hospitals and health insurers generally put a lot of effort into reducing the number of patients who are readmitted. They have identified certain populations that are more likely to be readmitted, including people who are uninsured, people with lower incomes, and people over the age of sixty-five. It is estimated that 20 percent of all hospitalizations of people sixty-five and older are readmissions. The readmission rate of this age group receives a great deal of attention because the people in it are more likely to have more than one health issue that can cause hospitalization, and they are likely to experience a number of factors that can contribute to readmission.
Several factors may lead to hospital readmission. Some result from the actions of the hospital and its staff. For instance, if a patient is discharged too soon after a procedure or is exposed to an infection while in the hospital, the patient is likely to end up readmitted within a few days or weeks of the initial discharge. Other times, a patient returns because of a breakdown in follow-up care. A patient who does not understand the discharge instructions or who cannot or will not follow them may be readmitted. Failure to fill or to take prescriptions, to make or keep follow-up appointments with a physician, or to follow guidelines for proper wound care, hygiene, and nutrition can also result in a patient needing to be readmitted.
Hospitals are increasingly taking steps to limit the number of readmissions for all patient populations but especially with individuals over the age of sixty-five. They have identified a number of specific causes of readmission and devised strategies for minimizing these causes, even those that occur after discharge.
One study published in Annals of Internal Medicine in 2015 and conducted at the Beth Israel Deaconess Medical Center found that the reasons for readmission could differ based on how soon after the initial stay readmission occurs. The study found that readmissions that occurred within eight days of initial discharge were likely to be due to a problem directly related to the initial stay. Patients who were readmitted more than eight but fewer than thirty days after initial discharge most likely had a problem related to their follow-up care. The study found that anything that impeded the patient's access to care was likely to increase the odds of readmission. Some of these impediments included a miscommunication regarding care instructions, a lack of health insurance, the cost of copays for prescriptions and follow-up visits, and the lack of a support system to assist with daily needs involving hygiene and nutrition.
Steps some hospitals take to reduce readmissions include additional staff training to ensure patients are properly prepared for discharge and coordination with the patient's physician and other caregivers to guarantee the discharge instructions are understood and followed. In some cases, they might also investigate the situation into which the patient is being discharged. For instance, the staff will try to find out if the patient will have necessary assistance at home, access to a physician, and the ability to pay for needed medications. Some hospitals have begun experimenting with providing thirty-day supplies of prescriptions at discharge, arranging follow-up appointments and transportation for the time after discharge, and making follow-up calls to check on any problems a patient may be having.
Bibliography
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