Hospital Readmissions Not Linked to Care Coordination Lapses

Patient readmissions are often related to expected surgical complications after discharge, rather than poor care coordination or mismanagement, new research published in the February 3, 2015, edition of JAMA suggests.

According to the study authors, surgical-site infections accounted for 19.5% of unplanned readmissions and were the most common reason for returning to the hospital. The researchers noted that complications were not present during patient discharge more than 97% of the time.

“These results clearly demonstrate that the vast majority of complications that cause readmissions are not due to a lack of coordination or complications that occurred during the initial hospitalizations,” said Karl Y. Bilimoria, MD, MS, a surgical oncologist and vice chair for quality at Northwestern Memorial Hospital and director for Surgical Outcomes at Northwestern University Feinberg School of Medicine, in a press release. “These complications were new and occurred after patients were discharged and were recovering at home.”

Researchers analyzed readmission rates from 346 US hospitals during 2012, which included reasons for readmission from the medical records, treating physicians, and patients. They concentrated on 6 specific surgery types and a cohort of 498,875 patients.

Additional complications prompting readmissions included delayed return of bowel function, dehydration or nutritional deficiency, bleeding, intravenous blood clot, and prosthesis or graft issues.

“Many of the issues that were identified can help hospitals better focus their efforts to continue to reduce potential readmissions,” Dr. Bilimoria said. “Our results also highlighted that many of the complications involved in readmissions, such as surgical-site infections, are already well-known and part of other [Centers for Medicare & Medicaid Services] pay-for-performance programs, which means hospitals are effectively being penalized twice for the same complications.”

Although complications varied depending on the procedure, some of the complications could be addressed through better communication with patients, education, and care redesign, the researchers said.