Now, where I trained, we were the only useful facility for hundreds of miles – so we actually had a a lot of continuity of care in the Emergency Department. And nothing beat the continuity we saw when a patient who was discharged in the morning was back in our Emergency Department by evening – and the inevitable question of “how did they screw this up?”
This is a retrospective look at the readmissions from 11 teaching and community hospitals trying describe the readmissions as avoidable vs. unavoidable, characterize the cause for readmission, and see if there were any baseline characteristics that might predict readmission. They found avoidable readmissions were in the minority, and there was no useful predictive clinical information regarding baseline differences between the readmitted group and the overall cohort – comorbidities, length of stay, new medications, etc. When patients were avoidably readmitted, however, several recurring factors were noted:
– Management error (48% of the time)
– Surgical complications (38.5%)
– Medication-related event (32.7%)
– Nosocomial infection (18.3%)
– System error (15.4%)
– Diagnostic error (10.6%).
Considering CMS is looking closely at decreasing payments to physicians and hospitals for readmissions, this study provides a small amount of systematic insight into some of the things we’ve all observed anecdotally.
“Incidence of potentially avoidable urgent readmissions and their relation to all-cause urgent readmissions.”
www.cmaj.ca/content/early/2011/08/22/cmaj.110400