088Frail, Falling, Alone – 30-Day Readmissions not just about Hospital Care. A Prospective Study in a Large Irish Teaching Hospital

Abstract

Background: Unplanned readmissions within 30 days of a previous (index) admission are common (10%.30%) and significantly impact healthcare costs [1]. Policy makers are using readmissions as a quality indicator and penalising Trusts. We suggest that readmissions are complex and involve multiple factors other than quality of care. Methods: All medical readmissions within 30 days of index admission were captured prospectively over a 3 month period (2016). Data was collected using electronic patient records and chart reviews. The CURIOS@ questionnaire created by the Safer@home group [2] acted as a data collection template. Ethics approval was granted. Results: The readmission rate was 11.4% (n = 204). Median age was 70 years. Males accounted for 53.7%. A Clinical Frailty score of.5 was found in 37.8%. At least one fall in the previous 6 months occurred in 35.4%. Almost 60% of patients were on.8 medications. Respiratory infections (17%), falls (8.7%), cardiac failure (8.7%) and urinary tract infection (6.8%) were the principle diagnoses. The most frequent living situations at readmission were: 23% at home with partner/family and no external help; and 19.6% living alone. Conclusions: This study suggests that readmitted patients have a high proportion of complicating Patient and Disease Factors including frailty, falls, polypharmacy, living with partner/family (and no external help), and living alone. These factors stand apart from hospital care and indicate that readmissions are complex and multifactorial. We recommend policy makers consider Patient and Disease Factors when defining readmissions as a hospital quality indicator.