Patients and healthcare professionals’ voice on preventable readmissions

Abstract

Introduction Currently, about 10% of patients required unplanned readmissions within 30 days after discharge.1 2 This proportion has not changed substantially over the past several years despite intense efforts to improve the discharge process. Although several studies3 4 have been performed, including patients’ and physicians’ opinion on the preventability of readmissions and factors that would predict preventability, only a few studies have included nurses’ opinions and the consensus with all stakeholders.5 We aimed to determine the patient’s opinion on preventable readmission, associated factors and the extent to which patients, nurses and physicians agree on readmission preventability. Methods To achieve the proposed objectives, a descriptive transversal correlational multicentre study was developed. This study was approved by the Clinical Research Ethics Committee (reference number: PR114/17). From 2 April 2017 to 18 January 2019, all patients readmitted within 30 days to 2 medical and 2 surgical departments (internal medicine, pneumology, trauma and digestive surgery) at 4 university hospitals were identified. Patients who provided written informed consent were interviewed within 72 hours of readmission. Four research nurses were trained to deliver the interviews. The patient’s interview involved 23 questions6 about functional status at discharge, discharge process and follow-up care, including readmission preventability (online supplemental material). Two independent physicians and nurses of the research team concurrently reviewed electronic health records to identify factors contributing to potentially preventable readmissions.7 Clinical and demographic patients’ characteristics were also collected. We estimated that a total sample size of 276 patients was needed for a proportion of 11% of preventable readmission,7 95% confidence level and 0.04 precision and assuming 15% potentially missed cases. A logistic regression model has been used to assess the association between the patient profile and his answer to the main question of his readmission preventability. The conditions of application of the models have been validated and CIs at 95% of the estimator have been calculated whenever possible. Cohen’s kappa statistic has been calculated to assess the concordance between physicians’, nurses’ and patients’ answer to this preventability readmission question. All the analysis has been done with the statistic package R V.3.5.3 (11 March 2019) for Windows. Patients were not involved in the design, conduct, reporting or dissemination plans of this study. Results We assessed 805 consecutive patients for eligibility, of whom 529 were excluded refused or unavailable (314 presented haemodynamic instability, 107 were discharged early, 104 refused to participate and four had language barrier). Among 276 patients included, 44.2% were admitted to internal medicine, 13.8% pneumology, 8% trauma and 34.1% digestive surgery department, respectively. The mean age was 68 years and 65.9% were men. The median (IQR) time between discharge and readmission was 11 days (5–17 days) and the median (IQR) Charlson comorbidity index was 5 (3–6). Ninety-six (34.8%) patients reported that their readmission was preventable, 69 (25.0%) were undecided and 111 (40.2%) reported that their readmission was not preventable. Comparing patients who reported non-preventable readmissions to those who reported preventable readmissions or were undecided, the latter had less time between discharge and readmission, did not have a follow-up appointment scheduled with primary care or specialist at discharge, no medication reviewed and felt concerns were not addressed before discharge. Also, patients who were less satisfied with the hospital’s discharge team, who felt were discharged before being ready and felt concern during follow-up care were more likely to report preventable readmission or undecidedness