Readmissions after nonoperative trauma: Increased mortality and costs with delayed intervention

McCrum, Marta L.; Zhang, Chong; Presson, Angela P.; Nirula, Raminder

doi:10.1097/ta.0000000000002560

Cited by 8 publications

(5 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The current body of literature evaluating readmissions among trauma patients has focused on association with particular injury patterns, 26 patient characteristics, 3 discharge destination, 23 time to intervention, 27 and inpatient laboratory markers. 28 However, the current study suggests that the readmissions that are most likely to be prevented may not be associated or may even be inversely associated with the severity of the patient's injuries.…”

Section: Discussionmentioning

confidence: 99%

Targeting zero preventable trauma readmissions

Neiman

Brown

Montgomery

et al. 2021

J Trauma Acute Care Surg

View full text Add to dashboard Cite

BACKGROUND:Nearly 1-in-10 trauma patients in the United States are readmitted within 30 days of discharge, with a median hospital cost of more than $8,000 per readmission. There are national efforts to reduce readmissions in trauma care, but we do not yet understand which are potentially preventable. Our study aims to quantify the potentially preventable readmissions (PPRs) in trauma care to serve as the anchor point for ongoing efforts to curb hospital readmissions and ultimately, bring preventable readmissions to zero. METHODS:We identified inpatient hospitalizations after trauma and readmissions within 90 days in the 2017 National Readmissions Database (NRD). Potentially preventable readmissions were defined as the Agency for Healthcare Research and Quality-defined Ambulatory Care Sensitive Conditions, in addition to superficial surgical site infection, acute kidney injury/acute renal failure, and aspiration pneumonitis. Mean costs for these admissions were calculated using the NRD. A multivariable logistic regression model was used to characterize the relationship between patient characteristics and PPR. RESULTS:A total of 1,320,083 patients were admitted for trauma care in the 2017 NRD, and 137,854 (10.4%) were readmitted within 90 days of discharge. Of these readmissions, 22.7% were potentially preventable. The mean cost was $10,001/PPR, resulting in $313,802,278 in cost to the US health care system. Of readmitted trauma patients younger than 65 years, Medicaid or Medicare patients had 2.7-fold increased odds of PPRs compared with privately insured patients. Patients of any age with congestive heart failure had 2.9 times increased odds of PPR, those with chronic obstructive pulmonary disease or complicated diabetes mellitus had 1.8 times increased odds, and those with chronic kidney disease had 1.7 times increased odds. Furthermore, as the days from discharge increased, the proportion of readmissions due to PPRs increased. CONCLUSION:One-in-five trauma readmissions are potentially preventable, which account for more than $300 million annually in health care costs. Improved access to postdischarge ambulatory care may be key to minimizing PPRs, especially for those with certain comorbidities.

show abstract

Section: Discussionmentioning

confidence: 99%

Targeting zero preventable trauma readmissions

Neiman

Brown

Montgomery

et al. 2021

J Trauma Acute Care Surg

View full text Add to dashboard Cite

show abstract

“…Despite similar social determinants being present, the findings of cost analysis will likely be unique in different hospital systems depending on the availability of individual community resources. 7,9,10,[22][23][24][25] While some papers have standardized costs to "Medicare" costs, our patient population was generally too young to apply this method. Additionally, hospital cost does not provide information regarding reimbursement.…”

Section: Limitations and Next Stepsmentioning

confidence: 99%

“…6 Analysis of acute care costs has been successful in identifying differences within the general trauma population. 5,7 Julliard 8 et al used hospital costs to compare the utility of hospital-based interventions, making it an attractive baseline for a needs assessment.…”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11][12] Using hospital costs to identify subpopulations with frequent or costly treatment failures could help streamline needs assessment and intervention efforts. 7,13 Revisit costs represent an opportunity to estimate the frequency and complexity of these occurrences and identify areas for improvement with respect to cost savings, patient experience, and discharge planning.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Emergency department visit patterns in the recently discharged, violently injured patient: Retrospective cohort review

Kleber

Kravitz‐Wirtz²,

Buggs³

et al. 2023

The American Journal of Surgery

View full text Add to dashboard Cite

“…Other studies have found that 4%–14% of adult trauma patients returned to the hospital within 30 days of discharge, with the most common reasons being inadequate pain control, wound complications, uncontrolled comorbid health conditions, or psychosocial factors (Killien et al., 2021; Petrey et al., 2015; Shellito et al., 2020). Posthospitalization complications and readmission are costly and associated with increased patient mortality (Flood et al., 2013; McCrum et al., 2020; Neiman et al., 2021).…”

mentioning

confidence: 99%

Trauma Patient-Centered Discharge Plan Form: A Pilot Study

Stricker,

Running,

Lucas

et al. 2024

Journal of Trauma Nursing

View full text Add to dashboard Cite

BACKGROUND: Comprehensive and multidisciplinary discharge planning can improve trauma patient throughput, decrease length of hospitalization, increase family and patient support, and expedite hospital discharge. OBJECTIVE: This study aimed to assess the feasibility and acceptability of implementing a patient-centered discharge plan form for adult trauma patients. METHODS: A single-center pilot study was conducted with adult trauma patients on a neurosurgical medical-surgical floor at a Level II trauma center in the Western United States from January to February 2023. The study had three phases: observation, pilot intervention, and follow-up. The key pilot intervention was the development of a standardized patient-centered discharge plan form, pilot tested by a trauma advanced practice provider and an inpatient discharge nurse. The primary outcome was the frequency of discharge orders being written before noon on the day of discharge. Qualitative and quantitative outcomes are reported. RESULTS: The discharge form was used for eight patients during the pilot intervention phase; an advanced practice provider and an inpatient discharge nurse each completed the forms for four patients. Five of eight observed patients had discharge orders before noon; the incidence of orders before noon was slightly higher when the form was completed by the discharge nurse (three of four patients) than by the advanced practice provider (two of four patients). CONCLUSIONS: The pilot study found that the patient-centered discharge plan form was feasible and acceptable to help improve the discharge process for trauma patients. Additional work to further refine the form's content and administration is warranted.

show abstract

Readmissions after nonoperative trauma: Increased mortality and costs with delayed intervention

Cited by 8 publications

References 32 publications

Targeting zero preventable trauma readmissions

Targeting zero preventable trauma readmissions

Emergency department visit patterns in the recently discharged, violently injured patient: Retrospective cohort review

Trauma Patient-Centered Discharge Plan Form: A Pilot Study

Contact Info

Product

Resources

About