Rapid (7-Day) Readmissions to an Inpatient Medical Service at a Tertiary, Academic Medical Center.

Abstract

Background: Rapid readmissions, occurring within 7 days of hospital discharge, are associated with significant morbidity and mortality. Objectives: Identify causes of rapid readmissions with a focus on clinical judgement errors and improve discharge practices.

Methods: Records of 371 patients discharged from an inpatient medical service and readmitted within 7 days were reviewed. Causes for readmission were identified and classified into 10 categories, including diagnostic and/or therapeutic error leading to readmission.

Results: Fifty percent of rapid readmissions were related to severity of underlying disease/failure to respond to treatment. Adherence challenges, patients with known high hospital utilization, and substance use disorder/uncontrolled psychiatric conditions accounted for 32.4% of 7-day readmissions. Readmissions related to clinical judgement accounted for 24 (6.5%) of the total readmissions. Clinical judgement errors were comprised of 6 diagnostic and 18 therapeutic errors, involving infections, diabetic medications and anticoagulation agents.

Conclusions: Most rapid readmissions are related to the severity of the condition during the index hospitalization. Clinical judgement errors are a rare cause for rapid readmission and involve certain high-risk medications and symptoms which require a high degree of awareness from the discharging provider.