42HOW DO WE REDUCE READMISSIONS?

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Abstract

Evidence-base: Emergency readmissions within 30-days of hospital discharge are used as a performance indicator and since 2011 have imposed a financial penalty for NHS Trusts.

Penalties for readmissions are predicted to cost Trusts £4 million in lost income annually (Sg2 ‘Service Kit: Reducing 30-Day Emergency Readmissions’ July 2011). The current financial climate provides strong impetus to reduce readmissions, but how to achieve this is unclear as systematic reviews have failed to conclude risk factors for readmission, rates of preventable readmissions and solutions (RAND 2012).

Change strategies: Historical audits suggest that readmission rates in our department are stable despite many system changes.

We introduced a key to standardise case-note review and 2 Consultant Geriatricians used it to review 6 readmitted patients' case-notes independently each month for 1-year. They discussed their findings to identify modifiable causes of readmission and presented these along with directorate readmission figures at 2-monthly clinical governance meetings.

After 4-months, it became apparent that readmissions occurring more than 7-days after discharge were rarely linked to the index admission. Only those within 7-days were reviewed thereafter.

Change effect: Readmission rates were not reduced by this intervention.

The majority of readmissions were felt to be predictable but without an identifiable modification that might have prevented readmission.

Interventions: to reduce readmissions on an individual case basis were identified but none that could inform systematic changes at directorate or trust level.

Conclusions: Reviewing case notes and presenting findings to our department did not reduce readmissions.

Readmissions occurring greater than 7-days after discharge were rarely related to the original admission.

In some cases, a longer length of inpatient stay might have prevented readmission. Length of stay is also a performance indicator and addressing one factor may adversely affect the other.

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