Background: There are limited data on factors associated with 30-day readmissions and the frequency of avoidable readmissions among patients with stroke and other cerebrovascular disease. Methods: University HealthSystem Consortium (UHC) database records were used to identify patients discharged with a diagnosis of stroke or other cerebrovascular disease at a university hospital from January 1, 2007 to December 31, 2009 and readmitted within 30 days to the index hospital. Logistic regression models were used to identify patient and clinical characteristics associated with 30-day readmission. Two neurologists performed chart reviews on readmissions to identify avoidable cases. Results: Of 2706 patients discharged during the study period, 174 patients had 178 readmissions (6.4%) within 30 days. The only factor associated with 30-day readmission was the index length of stay >10 days (vs <5 days; odds ratio [OR] 2.3, 95% CI [1.4, 3.7]). Of 174 patients readmitted within 30 days (median time to readmission 10 days), 92 (53%) were considered avoidable readmissions including 38 (41%) readmitted for elective procedures within 30 days of discharge, 27 (29%) readmitted after inadequate outpatient care coordination, 15 (16%) readmitted after incomplete initial evaluations, 8 (9%) readmitted due to delayed palliative care consultation, and 4 (4%) readmitted after being discharged with inadequate discharge instructions. Only 5% of the readmitted patients had outpatient follow-up recommended within 1 week. Conclusions: More than half of the 30-day readmissions were considered avoidable. Coordinated timing of elective procedures and earlier outpatient follow-up may prevent the majority of avoidable readmissions among patients with stroke and other cerebrovascular disease.

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Objective: Pharmacologically paralyzed patients frequently undergo continuous EEG monitoring (cEEG) to assess for seizures. However, cEEG is costly, consumes valuable resources and there is limited data regarding seizure frequency in this population.Methods: Clinical and EEG data was collected from medical records for patients undergoing cEEG at Emory University between January 1, 2009 and August 31, 2011 and from an ICU EEG database between February 26, 2013 and July 2, 2014. Seizure incidence was compared between paralyzed and non-paralyzed patients. Neurological diagnosis, cEEG duration, medications and outcome were also assessed.Results: Three of the 103 (2.9%) paralyzed patients experienced seizures compared to 335/1955 (17.1%) that were non-paralyzed (p<0.001). Average duration of cEEG for patients receiving paralytics was 7.45 days vs. 2.38. Most patients in the first study period had a poor outcome (60/64, 93.8%). In the second study period, there were more sedatives used in the paralytic group (median 3 vs. 0). Conclusion:Seizures in pharmacologically paralyzed patients are uncommon and likely related to coadministered sedatives while cEEG duration is long and patient outcomes are poor.Significance: cEEG may be unnecessary in patients undergoing pharmacological paralysis and alternative means of monitoring sedation like Bispectral index may be more cost effective.