Factors Contributing to All-cause 30-day Readmissions

Background Growing scrutiny of readmissions has placed hospitals at the center of readmission prevention. Little is known, however, about hospital nursing - a critical organizational component of hospital service system - in relation to readmissions. Objectives To determine the relationships between hospital nursing factors - nurse work environment, nurse staffing, and nurse education - and 30-day readmissions among Medicare patients undergoing general, orthopedic, and vascular surgery. Method and Design We linked Medicare patient discharge data, multi-state nurse survey data, and American Hospital Association Annual Survey data. Our sample included 220,914 Medicare surgical patients and 25,082 nurses from 528 hospitals in four states (CA, FL, NJ, & PA). Risk-adjusted robust logistic regressions were used for analyses. Results The average 30-day readmission rate was 10% in our sample (general surgery: 11%; orthopedic surgery: 8%; vascular surgery: 12%). Readmission rates varied widely across surgical procedures and could be as high as 26% (upper limb and toe amputation for circulatory system disorders). Each additional patient per nurse increased the odds of readmission by 3% (OR=1.03, 95% CI: 1.00-1.05). Patients cared in hospitals with better nurse work environments had lower odds of readmission (OR=0.97, 95% CI: 0.95-0.99). Administrative support to nursing practice (OR=0.96, 95% CI: 0.94-0.99) and nurse-physician relations (OR=0.97, 95% CI: 0.95-0.99) were two main attributes of the work environment that were associated with readmissions. Conclusions Better nurse staffing and work environment were significantly associated with 30-day readmission, and can be considered as system-level interventions to reduce readmissions and associated financial penalties.

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“…This definition has been used in previous studies of surgical readmissions and corresponds with the HRRP window of observation. 18, 19 …”

Section: Methodsmentioning

confidence: 99%

Organization of Hospital Nursing and 30-Day Readmissions in Medicare Patients Undergoing Surgery

Ma¹,

McHugh

Aiken

2015

Medical Care

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“…As such, the reasons for readmission differ from medical conditions, as does the degree to which they are preventable. 18,19 …”

Section: Introductionmentioning

confidence: 99%

Association of the Hospital Readmissions Reduction Program With Surgical Readmissions

et al. 2018

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Importance Readmissions after surgery lead to poor patient outcomes and increased costs. The Hospital Readmission Reduction Program (HRRP) penalizes hospitals with excess readmissions after specified medical and surgical discharges. Objective To evaluate the effect of this policy on readmissions after major joint surgery (targeted) and procedures with historically high rates not under its purview (non-targeted). Design Using a 20% Medicare sample we performed a retrospective cohort study of patients undergoing one of five major surgeries between January 1, 2006 and November 30, 2014. Setting Population based analysis. Participants Our study included 507,663 patients with targeted (total hip arthroplasty, total knee arthroplasty) and 164,472 patients with non-targeted (abdominal aortic aneurysm repair, colectomy, lung resection) procedures performed at 2,773 hospitals. Exposure Implementation of the HRRP policy. Main Outcomes and Measures We calculated hospital level 30-day risk-adjusted rates of readmission and observation stays using multivariable logistic regression models. Changes in these rates were analyzed for three distinct time periods (Pre-policy (1/1/2006 to 6/30/2010), Performance (7/1/2010 to 6/30/2013), Penalty (7/1/13 to 11/30/14)) corresponding to the HRRP implementation timeline for major joint surgery, using interrupted time series. Results Readmissions for all procedures decreased significantly over the study period. Readmission rates after targeted procedures decreased faster during the Performance period (slope: −0.060, 95% CI: −0.079 to −0.041) compared to the Pre-policy period (slope: −0.012, 95% CI: −0.027 to 0.034, p <0.002). For non-targeted procedures, readmission rates were decreasing during the Pre-policy period (slope: −0.20, 95% CI: −0.24 to −0.16) but stabilized during the Performance period (slope: 0.0084, 95% CI: −0.049 to 0.066, p <0.001). Use of observation stays increased slightly, accounting for 11% of the decrease in readmissions. Conclusions The HRRP effectively decreased readmissions for targeted procedures. There were no associated spillover effects for common non-targeted procedures. A better understanding of differences in impact of the policy across medical and surgical discharges will be necessary to further enhance its effects and generalizability.

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“…Recently studies have also been carried out to see readmission rates in patients undergoing urologic surgeries [789]. Among the various studies on 30-day unplanned readmissions across all fields, it has been observed that 9% to 59% of these readmissions are preventable [10]. There is no study till date focusing on 30-day readmission rates in patients undergoing endo-urological surgeries for upper urinary tract calculi.…”

Section: Introductionmentioning

confidence: 99%

Unplanned 30-day readmission rates in patients undergoing endo-urological surgeries for upper urinary tract calculi

et al. 2018

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PurposeTo see the 30-day unplanned readmission rates in patients underdoing endo-urological surgeries for upper urinary tract calculi we conducted this retrospective study at King George's Medical University, Lucknow, India. Unplanned readmissions not only add to healthcare costs but also are bothersome for the patients. There are many studies on 30-day unplanned readmissions in general surgical patients. Although similar studies have been done in certain urological procedures, no study has reported readmission rates or its risk factors in patients undergoing surgeries for upper urinary tract calculi.Materials and MethodsWe retrospectively reviewed our prospectively maintained database from 1st January 2009 to 31st December 2017, for the patients who underwent endo-urological procedures for upper urinary tract calculi and identified the patients who were re-admitted within 30 days of discharge.ResultsOut of the total 3,209 patients undergoing endo-urological procedures for upper urinary tract calculi 56 were re-admitted. The readmission rate was 1.74% over the study period. The most common etiology for readmission was sepsis followed by hematuria. The significant risk factors for readmission in bivariate analysis included male gender, age >65 years, current smoking, chronic obstructive pulmonary disease, diabetes mellitus, bleeding disorder, prior cardiac disease, and American Society of Anesthesiologists (ASA) class ≥3. In multivariate risk adjusted logistic regression analysis ASA class ≥3 was the only independent risk factor for readmission.ConclusionsThe readmission rates in endo-urological procedures for urolithiasis are less compared to other procedures. ASA class ≥3 is the most important independent predictor of unplanned 30-day readmissions.

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Factors Contributing to All-cause 30-day Readmissions

Cited by 123 publications

References 32 publications

Organization of Hospital Nursing and 30-Day Readmissions in Medicare Patients Undergoing Surgery

Organization of Hospital Nursing and 30-Day Readmissions in Medicare Patients Undergoing Surgery

Association of the Hospital Readmissions Reduction Program With Surgical Readmissions

Unplanned 30-day readmission rates in patients undergoing endo-urological surgeries for upper urinary tract calculi

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