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Background & objectives: Readmissions are often considered as an indicator of poor quality of care during previous hospitalization, although many of these are unavoidable or unrelated to the past admission. The identification of high-risk cases for readmissions and appropriate interventions will help not only reduce the hospital burden but also to establish the credibility of the hospital. So this study aimed to determine the readmission percentage in the paediatric wards of a tertiary care hospital and to identify the reasons and risk factors that can help minimize preventable re-hospitalizations. Methods: This prospective study from a public hospital included 563 hospitalized children, classified as first admission or readmissions. Readmissions were defined as one or more hospitalizations within preceding six months, excluding scheduled admissions for investigations or treatment. Reason-wise, the readmissions were classified into various categories, based on the opinion of three paediatricians. Results: The percentage of children getting readmitted within six, three and one month time from the index admission was 18.8, 11.1 and 6.4 per cent, respectively. Among readmissions, 61.2 per cent were disease-related, 16.5 per cent unrelated, 15.5 per cent patient-related, 3.8 per cent medication/procedure-related and 2.9 per cent physician-related causes. Patient- and physician-related causes were deemed preventable, contributing to 18.4 per cent. The proximity of residence, undernutrition, poor education of the caretaker and non-infectious diseases were associated with increased risk of readmission. Interpretation & conclusions: The findings of this study suggest that readmissions pose a substantial burden on the hospital services. The primary disease process and certain sociodemographic factors are the major determinants for the increased risk of readmissions among paediatric patients.
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Objective: To explore the difference in intensive care unit (ICU) readmission rate between high dependency unit (HDU) and general ward for the patients with severe liver disease (SLD), and reflect the effect of HDU on SLD patientse. Methods: A clinical cohort of patients transferred out of ICU was established, and patients with severe liver disease who were transferred to HDU& general ward from July 2017 to December 2021 in the intensive care Unit of the Fifth Medical Center of PLA General Hospital were continuously enrolled. The main liver function indexes and MELD scores between the two groups were compared. Analyze the differences in severity and ICU readmission rate of SLD patients transferred to different wards, and clarify the role of HDU in the management of SLD patient. Area under the receiver operating characteristic (AUROC) was used to investigate the value of MELD score in predicting the occurrence of return to ICU. Results: The level of INR, TB, ALT and MELD scores of SLD patients transferred to HDU were significantly higher than those of patients transferred to general ward (all P < 0.05). MELD > 17 was found in 70.7% of SLD patients transferred to HDU group, while MELD ≤ 17 was found in 61.9% of SLD patients in general ward group. The ICU readmission rate of all patients in this cohort was 11.4%. By MELD quartile stratification, patients with SLD whose MELD > 23 had a significantly higher ICU readmission rate (20.0%) than those with SLD whose MELD ≤ 23 (8.6%) (P = 0.020). The ICU readmission rate was 8.2% when MELD ≤ 23 in the HDU group and 9.1% when MELD > 23, showing no significant difference (P = 1.000). The ICU readmission rate was 8.8% when MELD ≤ 23 in the general ward group. ICU reentry rate increased significantly to 36.4% when MELD > 23 (P = 0.001). MELD Score predicts that the optimal cut-off value of SLD patients in general ward readmitted to ICU was 23.5. Conclusion: The high dependency unit could better admit patients with SLD who were transferred out of ICU and required step-down treatment, and significantly reduced the ICU readmission rate of patients with SLD who were transferred out of ICU with MELD > 23. The patients with SLD and MELD score > 23 are suitable to be transferred from ICU to HDU.
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Objective:At present, emergency acute heart failure unit has been gradually carried out in China. This study is to analyze the impact of acute heart failure unit on the mortality and readmission rate of acute heart failure (AHF) within 6 months after discharge.Methods:Patients with AHF admitted to Emergency Department and Department of Cardiology, Peking University People's Hospital between December 2019 and December 2020, were prospectively collected. Patients with complicated malignant tumor, stage 4-5 chronic kidney disease, automatic discharge, and incomplete medical history were excluded. The baseline data, past medical history, admission condition, and auxiliary examination were collected. After discharge, the information of oral drugs, hospital readmission and death were collected through outpatient medical records in clinical data center or telephone consultation. Patients were divided into the emergency acute heart failure unit treatment group (emergency AHFU group), emergency routine treatment group (outside AHFU group) and cardiology treatment group according to the different treatment locations. SPSS 25.0 software was used for comparison between groups, and a P<0.05 was considered as statistically significant. ResuIts:A total of 238 patients with AHF were enrolled, 28 patients died in hospital, and 210 patients were followed up. Four cases were excluded from malignant tumor during follow-up, and 6 cases were lost to follow-up. There were 40 cases in the emergency AHFU group, 67 cases in the outside AHFU group, and 93 cases in the cardiology treatment group. According to the prognosis, the patients were divided into the poor prognosis group ( n=83) and good prognosis group ( n=145). The age, sex, vital signs and cardiac function of patients in the emergency AHFU group were basically the same as those in the outside AHFU group at admission, and the proportion of patients in the emergency AHFU group using non-invasive positive pressure ventilation was higher (52.5% vs. 32.8%, P<0.05). The utilization rate of angiotensin converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor enkephalinase inhibitors, β-blockers, diuretics and other oral drugs was higher in the emergency AHFU group after discharge, and patients also had more regular follow-up (95% vs. 79.1%, P<0.05). The 6-month readmission rate (15.0% vs. 40.3%, P<0.05) and the 6-month readmission and mortality composite results of patients in the emergency AHFU group (17.5% vs. 43.3%, P<0.05) were significantly lower than those in the outside AHFU group. COX regression analysis showed that the readmission rate of patients in the emergency AHFU group was lower than that in the outside AHFU group ( OR=2.882, 95% CI:1.267~6.611, P=0.12). Compared with the cardiology treatment group, the AHFU group had higher systolic blood pressure, faster heart rate, NT-probNP level, higher proportion of NYHA grade Ⅳ and Killip grade Ⅲ cardiac function (all P<0.05). The proportion of non-invasive mechanical ventilation in the AHFU group was significantly higher than that in the cardiology treatment group (52.5% vs. 30.1%, P<0.05). After discharge, there were no significant differences between angiotensin converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor enkephalinase inhibitors and β-blockers. There were also no significant differences in readmission and mortality rate 6 months after discharge. Binary logistics regression analysis found that the independent risk factors of AHF were routine emergency treatment, age, female sex, coronary heart disease, and BUN peak. Conclusions:The emergency acute heart failure unit is an independent protective factor for acute heart failure and reduced readmission rates within 6 months and readmission and mortality composite outcomes. Older age, female sex, coronary heart disease and elevated BUN peak are independent risk factors affecting the prognosis of AHF, which should be identified and preventive measures should be taken early.
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Objective:To explore the effect of follow-up care based on the knowledge attitude belief practice theory on postoperative care quality and readmission rate for children with critical congenital heart disease (CCHD).Methods:From June 2018 to October 2020, 76 children with CCHD admitted to this hospital were selected and divided into 38 cases in the control group and 38 cases in the study group according to the random number table method. The control group was given routine follow-up care after discharge, and the study group was given follow-up care based on the knowledge attitude belief practice theory besides the routine follow-up care for the control group after discharge. The readmission rates during the follow-up period were compared between the two groups, and the quality of care and self-efficacy (GSES) of caregivers were compared between the two groups at discharge, 6 months after discharge.Results:During the follow-up period, the readmission rate of the study group was 2.63% (1/38) lower than that of the control group 18.42% (7/38) ( P<0.05); 6 months after discharge, the study group had higher scores of care quality in postoperative feeding, surgical incision care, medication after discharge, prevention of complications, and critical illness recognition than those of the control group [(10.56±1.12) vs (9.78±1.03), (10.92±1.05) vs (9.96±0.98), (10.62±1.32) vs (9.35±1.02), (10.95±1.03) vs (9.97±0.99), (11.05±0.80) vs (9.23±0.75), (10.56±1.35) vs (8.95±0.99)] (all P<0.05); 6 months after discharge, the caregiver′s GSES score of the study group was higher than that of the control group ( P<0.05). Conclusion:Follow-up care based on the knowledge attitude belief practice theory can improve the quality of postoperative care for children with CCHD, reduce the readmission rate, and improve the self-efficacy of caregivers.
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Objective:To explore the effect of individual rehabilitation intervention on the clinical outcome of patients with acute decompensated heart failure.Methods:A total of 152 elderly patients with acute decompensated heart failure in a tertiary hospital from January 2017 to December 2018 were selected and randomly assigned to the test group and the control group. The test group developed individualized interim rehabilitation interventions based on the evaluation results of balance, mobility, muscle strength and endurance of patients. The control group only performed routine rehabilitation related health care and discharge follow up, the short physical performance battery and the rate of all-cause readmission 6 months after discharge were compared between the two groups.Results:Finally, 144 patients finished the reseach, 72 patients in each group. After 3 months of intervention, the total scores of balance test, 4-meter timed walking, time to complete 5 chair rise and SPPB in the test group were 3.05±1.01, 3.74±0.58, 2.75±0.76, 9.44±2.16, while those in the control group were 2.82±0.86, 3.30±1.02, 2.24±0.74, 8.33±2.46. There was significant difference between the two groups ( t value was from -5.287 to -2.001, P<0.01) . Six months after discharge, the all-cause readmission rate was 12.5% (9/72) in the test group and 23.6% (17/72) in the control group, the difference was statistically significant ( t value was -0.348, P<0.05). Conclusions:The individual rehabilitation exercise based on the results of physical function evaluation can effectively improve the patients' body function and quality of life. Besides this, it can reduce the rate of all-cause readmission 6 months after discharge, which can provide reference for the transitional rehabilitation training of the elderly patients with acute decompensated heart failure.
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@#Background: Readmission after stroke is common, but limited data is available in West China. This study aimed to assess the frequencies and influencing factors of unplanned readmissions within 3 months after hospital discharge. Methods: This was a retrospective study in a single center. In our study, 596 ischemic stroke patients who were admitted to the Department of Neurology of West China Hospital from November 2011 to August 2012 were enrolled. Demographic data, disease data and follow–up data were collected at first admission and after 3 months of discharge. The readmission rate and risk factors were calculated. Results: Of 596 ischemic stroke patients, the readmission rate was 19.30% (115/596) within three-months, the top three reasons for readmission were needs of rehabilitation (74/115, 64.35%), recurrence of stroke (14/115, 12.17%), complications (11/115, 9.57%). The readmission was associated with older age, whether patients have indwelling catheter and endotracheal tube and pressure sores. (P < 0.05) Conclusions: The rate of readmission within 3 months in ischemic stroke patients was 19.30%. Greater attention should be paid to the elderly patients and patients with endotracheal tube on discharge to reduce readmission. Extended nursing care is also needed to reduce the readmission rate of patients with ischemic stroke.
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The hospital readmission rate has been widely used as an indicator of the quality of hospital care in many countries. However, the transferrability of this indicator that has been developed in a different health care system can be questioned. We reviewed what should be considered when using the risk-standardized readmission rate (RSRR) as a generic quality indicator in the Korean setting. We addressed the relationship between RSRR and the quality of hospital care, methodological aspects of RSRR, and use of RSRR for external purposes. These issues can influence the validity of the readmission rate as a generic quality indicator. Therefore RSRR should be used with care and further studies are needed to enhance the validity of the readmission rate indicator.
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Delivery of Health Care , Patient Readmission , Quality Indicators, Health CareABSTRACT
Objective: To analysis predictive value of red blood cell distribution width ( RDW) about the readmission rate of chron?ic heart failure ( CHF) patients and correlation factor analysis. Methods: A total of 150 patients with CHF in hospital were collected and divided into four groups by NYHA in 2014, class Ⅰ (n=41), class Ⅱ (n=21), class Ⅲ (n=51), class Ⅳ (n=37). Another 150 patients without CHF were selected as the control group. The correlation BNP and RDW was analyzed, the RDW differ?ences of among CHF four groups and control group was compared, the predictive value of about the readmission rate of CHF patients among at least one years was analyzed. Results: There was significant relationship about RDW and BNP ( r<0?01) , the differences of among CHF four groups and control group were significant ( P<0?05) , the relationship of the readmission rate of CHF patients a?mong at least one year and RDW was very obvious ( OR=1?684) . Conclusion: The level of RDW is obviously related with BNP and the level of heart failure in the CHF patients, also have the high predictive value about the readmission rate of CHF patients.
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Objective To explore the impact of intervention of weight management (WM)on readmission rate of patients with congestive heart failure(CHF).Methods sixty-six CHF patients were divided into the control group(34 cases)and the intervention group(32 cases).The patients in the intervention group received the weight management intervention for 6 months after discharge,while the control group was carried on the conventional education and follow-up.The ability of WM and readmission rate of patients due to onset of CHF were compared between the two groups.Results Six months after the intervention,significant differences were found on the scores of weight monitoring,WM related-knowledge,belief and practice in the intervention group,but only WM related-practice was improved in the control group.The readmission rote due to onset of CHF was reduced in the intervention group.Conclusions WM intervention could significantly improve the ability of WM and reduce readmission rate due to CHF onset of CHF patients.