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1 in 4 Readmissions Avoidable, Researchers Say

By Alexandra Wilson Pecci  
   April 11, 2016

More than half (52%) of readmissions identified as preventable could have been avoided "with efforts made during the initial admission," according to a study published in JAMA Internal Medicine.

Readmission prevention efforts run the gamut from slashing CAUTI rates, to training uninsured patients how to administer their own IV antibiotics.

But allocating resources to some basic steps of care can curb readmissions.

The author of a recent study suggests that improving communication, making sure patients are truly ready to be discharged before they are released, and providing better post-discharge resources can be effective.

"What could we have done to prevent this [readmission]?" is the question that Andrew Auerbach, MD, MPH, a hospitalist at University of California San Francisco Health and professor of medicine at the UCSF Division of Hospital Medicine, and his team aimed to answer with their research.

He was lead author of a study published in JAMA Internal Medicine this month, that found readmissions could be prevented in 27% of cases.

In a study of 12 academic medical centers nationwide, researchers examined 1,007 readmissions occurring within 30 days of discharge, interviewed patients and their doctors, and scoured medical records, Auerbach says.

The researchers were not only looking at how sick the patients were, but also at identifying "system flaws and gaps in care that could have been avoided with reasonable patient or physician activities," such as a patient's inability to get a discharge appointment, the study says.

Their review found that 27% of readmissions were considered preventable. More than half (52%) of those preventable readmissions could have been avoided "with efforts made during the initial admission," the study says.

Auerbach says the research team saw problems everywhere: From how patients were engaged in making sure they could handle their own care at discharge, to poor communication between hospitalists and primary care doctors.

There were also problems in the emergency department, which Auerbach called "the canary in the coalmine" for many healthcare system flaws, in cases where a patient who was readmitted through the ED probably didn't need to be. Although readmissions could have been avoided through better outpatient care, the ED is "doing the best [it] can under very limited circumstances," Auerbach says. 

Discharging patients before they're ready also led to readmissions, but is an "interesting and somewhat thorny problem," Auerbach says. He notes that although efficiency is needed, it's not cost-effective to keep patients in the hospital too long, either. The study found a reasonably large number of patients who could have benefitted from spending another day in the hospital.

"We're all kind of hand-waving at this point because we're all trying to figure out what the balance here is," he says.

The study found that working to improve the following aspects of healthcare could help reduce preventable readmissions:

  • Emergency Department care coordination
  • Inability to keep post-discharge appointments
  • Lack of disease monitoring
  • Premature discharge from hospital
  • Patient lack of awareness of who to contact after discharge

Auerbach notes that this study was one of the first to take national, multicenter look at the underlying causes of readmissions, including talking with the patients themselves and looking at specific processes of care.

This study dovetails with other research that Auerbach has recently worked on: Developing the HOSPITAL score, an acronym created to identify the variables associated with 30-day hospital readmissions, which Auerbach calls "elegant."

So if the HOSPITAL score can be used to predict who will be readmitted, the new JAMA Internal Medicine study seems to point the way for how to holistically deal with the issue.

"We're kind of the, 'stop smoking, eat better, and exercise' solution to the problem," Auerbach says.

Alexandra Wilson Pecci is an editor for HealthLeaders.


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