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Preventability of 28-Day Hospital Readmissions in General Internal Medicine Patients: A Retrospective Analysis at a Quaternary Hospital

Shuster, Constantin, MD; Hurlburt, Andrew, MD; Yung, Terence, MD; Wan, Tony, MD; Staples, John A., MD, MPH; Tam, Penny, MD

doi: 10.1097/QMH.0000000000000174
Quality Improvement
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SDC

Background: Unplanned hospital readmissions are associated with increased patient mortality and health care costs, yet only a fraction are likely to be preventable. This study's objective was to identify preventable hospital readmissions of general internal medicine patients, and their common causes.

Methods: Patients who were discharged from the general internal medicine teaching service and readmitted to hospital within 28 days for 24 hours or more were recruited to the study; they were identified via the hospital electronic medical record system. Data were gathered via structured review of hospital charts/electronic medical records, along with standardized patient interviews. Unique to our study, a multidisciplinary panel of physicians, nurses, and hospital administrators adjudicated preventability and identified common causes of readmission.

Results: Fifty-five hospital readmissions were identified; 53% were adjudicated to be preventable. There was no difference in any variable analyzed between preventable and nonpreventable readmissions. The most common causes of preventable readmissions were inadequate coordination of community services upon discharge, insufficient clinical postdischarge follow-up, and suboptimal end-of-life care.

Conclusion: This study identified a higher proportion of preventable 28-day hospital readmissions when compared with prior research. Increased involvement of palliative care during initial hospitalization for appropriate conditions and improvements in care after discharge may reduce preventable hospital readmissions.

Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada (Drs Shuster, Hurlburt, Yung, Wan, Staples, and Tam); and Centre for Clinical Epidemiology & Evaluation, Vancouver, British Columbia, Canada (Dr Staples).

Correspondence: Constantin Shuster, MD, Division of General Internal Medicine, Department of Medicine, 2775 Laurel St, 10th Floor, Vancouver, BC V5Z 1M9, Canada (c.shuster@alumni.ubc.ca).

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.qmhcjournal.com).

All authors contributed to the design and conduct of the study. C.S. wrote the first draft of the manuscript and all authors contributed to its revision. All authors approved the final manuscript.

The authors gratefully acknowledge Jennifer Petersen for her help with conducting patient interviews and adjudicating preventable hospital readmissions. The authors also thank Susan Seeman for her help adjudicating preventable hospital readmissions.

The authors declare no conflicts of interest.

© 2018Wolters Kluwer Health | Lippincott Williams & Wilkins