M. G. Rosenthal1, J. H. Ra1, D. Ebler1, D. J. Skarupa1, J. J. Tepas1, T. S. Hester1, S. Saquib1, A. J. Kerwin1 1University Of Florida COM-Jacksonville,Acute Care Surgery,Jacksonville, FL, USA
Introduction: In an era of decreasing reimbursements the incentive to decrease readmissions has never been greater. It has been suggested that trauma readmission is an indicator of poor hospital care or fragmented discharge. Even though readmissions are relatively low readmissions add significant cost, are resource intensive, tie up already limited resources and lead to worse outcomes, including mortality. Between 15 to 38% of trauma readmissions require an operation during readmission and are associated with a 4.6% mortality rate.
The Affordable Care Act will penalize hospitals for unplanned readmissions. While this does not pertain to trauma patients currently, there is concern that in the future it will. The 30 day rate of unplanned readmission in US Medicare patients is estimated to be 20% for both medical and surgical patients. The literature suggests that trauma patients have a lower readmission rate compared to medical and surgical patients. Further studies are needed to determine reasons for readmissions and risk factors that predispose patients to unplanned readmissions. Once these have been elucidated efforts can be made to highlight patients who are at increased risk and enact strategies to reduce preventable readmissions.
Methods: This is a retrospective review of trauma patients over the age of 16 with an unplanned readmission within 30 days of discharge. Cases registered from July, 2012 to June, 2015 were included from our Level 1 trauma center registry. Reasons for readmission were categorized and patient outcomes following readmission were evaluated as well as hospital resource usage.
Results: Of 5,650 patients, 159 (2.81%) required unplanned readmission. The most common reasons were disease/ symptom progression (30.2%), wound complications (28.9%), pain control (11.8%) and VTE disease (9.4%). Missed injuries accounted for 3.1% of readmissions. 76 (48%) required a surgical or invasive procedure. 63% were readmitted within 1 week of initial discharge and 60.3% required less than 1 week LOS after readmission . The mean LOS after readmission was 7 days. The mortality rate for those requiring readmission was 3.1%.
Conclusion: Our trauma readmission incidence and readmission mortality rate is consistent with previously published studies. Given that the preponderance of these occur within 1 week after discharge, are for disease/symptom progression or pain control and require a hospital stay less than 7 days trauma programs should use their quality management programs to identify system improvements to reduce these types of readmissions. This will benefit both patients and hospitals.