ObjectiveTo investigate whether number of doses per day and number of medications are significantly associated with the number of readmissions and to study the association of readmission frequency with other medical and socio-demographic variables.MethodsRetrospective cross-sectional study involving 432 patients who were readmitted within 15 days of previous hospital discharge between January 1, 2013 and March 31, 2013. Relevant medical records were collected from the national electronic databases of every public tertiary hospital in Singapore. Significant variables (p < 0.05) were identified using forward selection and modeled using generalized linear mixed models.ResultsA total of 649 unplanned readmissions were reviewed. At a multivariable level, number of readmission was significantly associated with the number of medications (p = 0.002) and number of doses per day (p = 0.003) after adjusting for race, liver disease, schizophrenia and non-compliance.ConclusionComplex medication regimen (i.e. multiple medications and multiple doses per day) is a statistically significant predictor of number of readmissions. Simplifying therapeutic regimens with alternatives such as longer-acting or fixed-dose combination drugs may facilitate better patient adherence and reduce costly readmissions.

Increased length of stay (LOS) in the hospital incurs substantial financial costs on the healthcare system. Multiple factors are associated with LOS. However, few studies have been done to associate the impact of Total Daily Doses (TDD) and LOS. Hence, the aim of this study is to examine the association between patients' LOS upon readmission and their TDD before readmission. A retrospective cross-sectional study of readmission cases occurring from 1st January to 31st March 2013 was conducted at a regional hospital. Demographics and clinical variables were collected using electronic medical databases. Univariable and multiple linear regressions were used. Confounders such as comorbidities and drug related problems (DRP) were controlled for in this study. There were 432 patients and 649 readmissions examined. The average TDD and LOS were 18.04 ± 8.16 and 7.63 days ± 7.08 respectively. In the univariable analysis, variables that were significantly associated with the LOS included age above 75 year-old, race, comorbidity, number of comorbidities, number of medications, TDD and thrombocytopenia as DRPs. In the multiple linear regression, there was a statistically significant association between TDD (β = 0.0733, p = 0.030) and LOS. Variables that were found significant were age above 75 year-old (β = 1.5477, p = 0.008), Malay (β = -1.5123, p = 0.033), other races (β = -2.6174, p = 0.007), depression (β = 2.1551, p = 0.031) and thrombocytopenia as a type of DRP (β = 7.5548, p = 0.027). When TDD was replaced with number of medications, number of medications (β = 0.1487, p = 0.021), age of 75 year-old (β = 1.5303, p = 0.009), Malay (β = -1.4687, p = 0.038), race of others (β = -2.6499, p = 0.007), depression (β = 2.1951, p = 0.028) and thrombocytopenia as a type of DRP (β = 7.5260, p = 0.028) were significant. In conclusion, a significant relationship between TDD and number of medications before readmission and the LOS upon readmission was established. This finding highlights the importance of optimizing patients' TDD in the attempt of reducing their LOS.

Objectives: Our study aimed to explore to what extent the priority areas and domains of the World Health Organization (WHO)'s third Global Patient Safety Challenge were being addressed in a sample of hospital organisations.Methods: A qualitative approach was taken using a combination of focus groups, semistructured interviews and documentary analysis in four UK teaching hospital organisations. A purposive sampling strategy was adopted with the aim of recruiting healthcare professionals who would be likely to have knowledge of medication safety interventions that were being carried out at the hospital organisations. Medication safety group meeting notes from 2017 to 2019 were reviewed at the hospital organisations to identify interventions recently implemented, those currently being implemented and plans for the future. A content analysis was undertaken, using the WHO's third Global Patient Safety Challenge priority areas and domains as deductive themes.Results: All the domains and priority areas of the WHO Medication Safety Challenge were being addressed at all four sites. However, a greater number of interventions focused on 'healthcare professionals' and 'systems and practices of medicines management' than on 'patients and the public'. In terms of the priority areas, the main focus was on 'high risk situations', particularly high-risk medicines, with fewer interventions in the areas of 'transitions of care' and 'polypharmacy'.Conclusions: More work may be needed to address patient and public involvement in medication safety and the priority areas of 'transitions of care' and 'polypharmacy'.Comparative global studies would help build an international picture and allow shared learning.