Top Five Reasons for Hospital Readmissions
Transitioning home after a hospital stay may leave you feeling uncertain and fearful as you're left to face the rest of your recovery on your own. You’re on high alert for returning or new symptoms, especially because you lose accessibility to the type of immediate care available in the hospital. Readmission rates are also affected by the complexity of your condition and how well you comply with treatment.
Up to a staggering 25% of people who are discharged from the hospital in the US return within 30 days, and up to 15% of readmissions are preventable. It's helpful to understand why patients return to the hospital to make sure you have an effective transitional care process in place.
1. Disengagement and Non-Compliance
Disengagement refers to a patient's disinterest or unwillingness to participate in their care, and non-compliance means they are not following their treatment plan. Disengagement and non-compliance are the top causes of preventable readmissions.
Patients who don't understand the importance of their treatments or don’t take them seriously may ignore their discharge instructions. Another factor that contributes to high readmission rates is the fact that half of all readmitted patients don't see their doctor for their follow-up appointments. The repercussions of not adhering to treatment and not communicating with your doctors could become dangerous.
For example, if you were to skip a few doses of an antibiotic, the infection may not heal and you could end up back in the hospital. If you were to skip your physical therapy appointments and homework, you could re-injure yourself and end up back where you started. If you're at high risk for a heart attack and don't make recommended changes to your diet and lifestyle, you could exacerbate your condition and end up in the hospital again.
It's essential to understand the rationale behind your treatment and follow it exactly as prescribed to avoid readmission.
2. Condition Complications
Several conditions have a higher risk of complications that lead to readmission. Research shows a high percentage of people with severe conditions such as congestive heart failure or those who undergo procedures such as amputation return to the hospital within 30 days. The following conditions also have a high rate of readmissions:
Chronic Kidney Disease with Heart Failure
Hypertensive heart disease
Urinary Tract Infection
Acute Kidney Failure
The severity and risks associated with these conditions contribute to high readmission rates. Some of the conditions never completely go away, and some naturally have high complication rates, which lead to a greater readmission risk.
For example, infections can develop around surgical wounds, or the symptoms of COPD might return. Sepsis from an antibiotic-resistant infection may make the condition more difficult to treat, which may cause you to return to the hospital.
Some complications are unavoidable, but an excellent care facility takes precautions and makes the appropriate arrangements to ensure you have adequate follow-up care.
3. Inadequate Transition of Care
Ideally, the hospital discharge and post-discharge process should prepare you to return home or to a care facility. The transition may include follow-up appointments, home visits, and detailed care instructions. When you leave the hospital, you should know what you need to do next and signs of any potential issues.
Quality medical centers ensure you're as equipped as possible for this transition, but sadly some do not put as much effort into the discharge process. Early discharge, inadequate communication during discharge, and poor coordination of care can lead to hospital readmission.
Think about leaving the hospital with a stack of papers and a head full of information from all different providers. Plus, you may need to adjust schedules, modify parts of your home, and make arrangements with loved ones to help you. Not only may you have trouble making those arrangements, but you might be overwhelmed, forget something, or feel unsure about what's most important. If you miss a crucial step in the recovery process due to a poor discharge process, you could end up back in the hospital.
When you have someone to summarize your post-hospital plan, coordinate follow-up appointments and medications for you, ensure proper arrangements are made, and make sure you understand all of it, the process will be much more successful. It's essential to evaluate the hospital's discharge procedure and ask lots of questions to ensure you don't end up there again.
4. Misinterpretation of Discharge Instructions
Similarly, some people are readmitted to the hospital because they misinterpret their discharge instructions. Perhaps they don't realize how serious their medication regimen is or think therapy isn't a big deal. Other times, they're unsure what the instructions mean or get conflicting information.
Let's say a patient is instructed to limit carbohydrates and they're not sure which foods contain carbs or why carbs are a big deal. As a result, they may eat more carbs than they're supposed to and irritate a gastronomical condition to the point of having to visit the emergency room.
Non-compliance is often a direct result of a misinterpretation of discharge instructions. You need to know exactly what your treatment plan entails and why. It's important to go over all directions with your provider and ask questions so you know what you should do and why it's crucial.
5. Demographic Factors
According to research, males, the elderly, and those of low socioeconomic status are more likely to return to the hospital than others. Those on Medicare and Medicaid were also far more likely to return to the hospital than patients with private insurance. A variety of factors contribute to these statistics, but their correlation is clear.
People who can't afford their prescriptions or don't have a ride to the pharmacy, for example, may avoid getting prescriptions filled. If their co-pays are too high, they may avoid necessary appointments. Sometimes cultural or physical barriers get in the way of communication as well.
It's hard to say what causes these demographic differences, but hospitals need to address these at-risk populations. Patients and their families must understand the necessary self-care measures and make arrangements to get to the pharmacy.
To respond to high readmission rates at some hospitals, Medicare developed the Hospital Readmissions Reduction Program (HRRP) to reduce hospital admissions within 30 days of discharge. Thankfully, hospitals are putting more effective plans in place to improve care and lessen the need for readmission.
Through inpatient rehabilitation, Summit Rehab goes above and beyond these standards of care to ensure patients are recovering and receiving the necessary post-acute care. Our post-acute inpatient services ensure patients make progress toward recovery and ultimately, don’t return to the hospital for the same condition over and over.
If you're looking for an inpatient rehab program for you or a family member reach out to Mitchell Hollingsworth for more information.
Source: Center for Healthcare Quality and Payment Reform (chqpr.org)
Causes of Early Readmissions | Journal of Hospital Medicine
Why do patients keep coming back? Results of a Readmitted Patient Survey (nih.gov)
AHRQ: The conditions that cause the most readmissions (advisory.com)