Transfer and readmission of patients between acute and community hospitals: a retrospective review

Ruth Endacott, Pat McDonagh, Jane Gidman, Rob Bromige, Marie-Helene Arti

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Background: Patients who are discharged from acute hospitals to community hospitals are often readmitted. We conducted a medical record audit for a sample of patients who were admitted to the acute hospital (AH), transferred to a community hospital (CH) and readmitted to the same acute hospital over a 12 month period. Aims: 1. To examine characteristics of patients who were readmitted to an AH after a CH stay. 2. To examine the appropriateness of actions prior to readmission from CH to AH. Methods: A retrospective review of patient records was undertaken between April 2012-March 2013 for one AH and ten CHs serving the same geographical location. Phase 1 audit entailed detailed review of the patient stay in AH and CH. We reviewed the complete AH and CH episode of care for 25 patients, giving 50 episodes of care. The Phase 2 audit entailed detailed review of the decision processes underpinning transfer/readmission for 40 patients and expert review of the appropriateness of the transfer. Results: The median age of the patients was 83 years (IQR 7.50). Median length of stay for the AH episode was 9 days (IQR 11.75). The patients reviewed were physiologically unstable during AH and CH episodes of care. However, none of the patients were acutely unwell in the few hours before transfer from AH to CH. Re-admission to the AH was undertaken out of hours (including weekend day time) for 39 (55 ) patients. In Phase 2 most readmissions were deemed appropriate (31/40; 77.5 ). Out of hours readmission across both phases was significantly associated with out of hours transfer (?2 4.812, p=0.028) and longer AH length of stay (? 2 12.751, p=0.047). Conclusions: Timing of transfer from AH to CH should be optimised to ensure patients are discharged when the full range of services is available. CH services could be configured differently with diagnostic and access to doctors provided for longer hours in a smaller number of CH.
Original languageEnglish
Pages (from-to)47 - 51
Number of pages5
JournalQuality in Primary Care
Issue number1
Publication statusPublished - 2015

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