Unplanned hospital readmissions can be considered as a quality indicator for hospital care. Our objective was to describe the risk factors and indications for post-partum readmissions.METHODS:
This is an observational study of prospectively collected data at one tertiary hospital. Patients were identified during obstetric safety rounds and physician board checkouts during 17 months.RESULTS:
Over period of 17 months, we had 7,126 deliveries, including 4,156 vaginal and 2,970 cesareans. Study group consisted of 106 patients with total 111 post-partum readmissions, with overall readmissions rate of 1.55%. Main indications for readmissions were: hypertensive disorders (43.2%) and wound complications (18.0%). Among 47 women who were readmitted for hypertensive disorders, 19 (40%) had de-novo onset of preeclampsia, versus 28 (60%) who had a history of hypertensive disorders. Among those 19 women with de-novo onset of preeclampsia, risk factors were obesity (BMI>30) (12), history of hypertensive disorders in previous pregnancies (4), nulliparity (4), gestational diabetes mellitus (2) and twin pregnancy (1). Eighteen patients were readmitted for surgical wound complications with 20 total readmissions. Twelve of 18 had repeat cesarean. For these women, risk factors for wound infection were obesity (BMI>30) (13), prolonged labor before cesarean delivery (5), history of diabetes (4), and steroid administration (7).CONCLUSION:
Developing protocols and improvement strategies that focus on risk factors with close surveillance and postpartum follow-ups in those identified as high-risk patients, might be a valuable key to reduce readmission rate. Reducing readmission rate gives a valuable opportunity to healthcare facilities to improve patient satisfaction and safety.